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Printable Handouts
Navigable Slide Index
- Introduction
- Discuss management of patients
- Cervical lymph node involvement reduces survival
- Historical perspective
- Anatomy of cervical lymphatics
- Patterns of lymphatic drainage
- Regional node drainage
- Contra-lateral metastases
- Goals of a neck dissection
- 2 scenarios
- Metastases from oral cavity tumours in N0 neck
- Elective neck dissections (N0)
- Selection of neck dissection
- Micro metastasis (occult metastasis)
- Micro-metastasis
- Analogy
- Occult metastasis: controversial
- Occult metastasis - tongue & FOM
- Occult metastasis - alveolar ridge
- Occult metastasis - FOM
- Occult metastasis – N0 & N+ neck
- Perineural & vascular invasion
- Tumour differentiation
- Oral tongue with clinically N0 neck
- Oral tongue with clinically N0 neck - level IV
- Anatomy of cervical lymphatics - level IV
- Damaging the sympathetic chain
- Level IIB – to dissect or not?
- Level IIB – completed SOHND
- Bilateral neck dissection in N0
- What about HPV-related cancers?
- Imaging of the neck
- The N0 neck imaging
- Ultrasound with colour flow Doppler
- Reactive node
- Ultrasound video
- Suspicious of malignancy
- Malignant nodes (1)
- Malignant nodes (2)
- Malignant node video
- Reactive vs. malignant node
- Microbubbles
- PET-CT in the N0 Neck
- Sentinel node
- Sentinel node biopsy
- Sentinel node biopsy study
- Sentinel node biopsy & imaging
- A published trial that might change management
- NEJM paper by D'Cruz
- Elective vs. therapeutic neck in N0
- SEND trial (selective elective ND)
- Summary
- Thank you
Topics Covered
- Patterns of spread of oral cancer
- Prognosis with metastatic neck disease
- Risk of occult metastasis
- Predictors of metastasis
- Tumour depth
- Perineural invasion
- Imaging of the node negative neck
- Sentinel lymph node biopsy
- Survival benefits of neck dissection
Links
Series:
Categories:
Therapeutic Areas:
Talk Citation
Brennan, P. (2017, March 30). Management of the N0 neck [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved October 14, 2024, from https://doi.org/10.69645/GOJP3289.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. Peter Brennan has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
Transcript
Please wait while the transcript is being prepared...
0:00
Hello, and welcome to a lecture
on the Management of the N0 Neck.
My name is Peter Brennan.
I'm a Consultant Maxillofacial surgeon,
working at the Queen Alexandra Hospital
in Portsmouth, UK.
And also, I have extensive experience
as a surgeon treating about 50 to 60
head and neck cancer patients per year,
including many neck dissections,
and as an honorary chair,
I have written about 400 papers,
many in the head and neck
involving controversies.
And hopefully,
this will be a simplified talk about
how to manage the N0 neck,
which is a controversial subject.
There's lots in the literature
both for neck dissection
and for observation.
I've tried to simplify the talk,
and hopefully at the end,
you'll have an understanding
of how to manage the clinically N0 neck.
0:47
I think it's worth saying that
for every single head and neck
cancer patient that we treat,
it's important to discuss the management
of every cancer patient
in the head and neck
multidisciplinary team.
And here, you can see a slide of us
sitting in the team meeting.
You can see a CT-scan up on the screen,
and in fact if you look
on the left neck,
you can see a very sizable lymph node
behind the left mandible there.
Every case is discussed by the team.
There's a radiologist as you can see
at the front presenting the imaging.
We have a pathologist.
There will be oncologists,
radiotherapists,
palliative care people,
speech and language therapists,
dieticians, a number of surgeons
both in ENT and oral
and maxillofacial surgery.
And so as a group,
we will discuss every single patient
and the best management for that patient
whether that be surgery, radiotherapy,
a combination of both,
or sometimes palliative care,
of course, as well.