Patients with oral cavity squamous cell carcinoma (SCC) will commonly require neck dissection as it is associated with a higher rate of overall and disease free survival. Free flap reconstruction of the defect following surgical resection is considered the gold standard. Commonly, a wide exposure is needed for neck dissection and free flap reconstruction. The authors propose a minimally invasive, endoscopically assisted technique, which they believe results in better aesthetic outcome, faster recovery and shorter hospital stay. The authors presented results of 12 patients who had minimally invasive selective neck dissection and simultaneous free flap reconstruction. Tumours resected ranged from floor of mouth, tongue, buccal mucosa and maxilla. In addition to standard dissection tools, the authors used a 300 4-mm endoscope, a Harmonic® scalpel and a long monopolar blade as well. A 5-cm incision was made from the leading edge of the sternocleidomastoid muscle to align horizontally with the hyoid bone. The majority of the operations used the radial forearm free flap and the facial artery and common facial vein were used as the recipient vessels. For dissection of levels I-III, they had an average nodal yield of 26 whilst patients who had levels I-IV clearance had an average nodal yield of 33. They had one patient returned to theatre for bleeding but reported no flap failure. The average operation time was 6.9 (5.5-8.0) hours and the mean inpatient stay was 15 days postoperatively. To date, the authors reported no local or regional recurrence. The nodal staging of the patients included in the authors’ series ranged from N0 to N2b. It appears through this technique the authors were able to obtain clearance of the neck with good lymph node yield combined with microvascular anastomosis without prolonged operating time.

Minimally-invasive neck dissection and free flap reconstruction in patients with cancer of the head and neck.
Hsu DWK, Sayan A, Ramchandani P, Ilankovan V.
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Wai Sum Cho

Queens Medical Centre, Nottingham, UK.

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