The first level of lymphatic spread in well-differentiated thyroid carcinoma is to the central compartment of the neck, namely, the paratracheal, prelaryngeal and pretracheal lymph nodes. Central neck dissection may carry an increased morbidity, namely, hypoparathyroidism and recurrent laryngeal nerve injury. The limits of central neck dissection are bordered by the hyoid bone superiorly, the suprasternal notch inferiorly (including the upper mediastinal lymph nodes), the common carotid artery laterally, and the trachea medially. Central nerve dissection refers to removal of the unilateral or bilateral paratracheal regions. The upper part of central neck lies between hyoid bone superiorly and cricoid cartilage inferiorly. The hypothesis of authors was that the upper part of central neck is devoid of lymphatic structures and need not be dissected as part of a routine central neck dissection. A total of 31 paratracheal neck dissections were performed. The surgical specimens were divided into upper and lower paratracheal regions, corresponding to the level of the cricoid. A median of 8 nodes were retrieved (range, 2-21). All metastatic lymph nodes were detected in the lower paratracheal region, and similarly all lymphatic structures were also located in the lower central neck dissection specimen. The upper specimens were devoid of lymphatic tissue or cancer-bearing lymph nodes and consisted of fibrofatty connective tissue only. This series challenges the need to dissect this area routinely as a part of central neck dissection for patients with well-differentiated thyroid cancer.

The upper limits of central neck dissection.
Holostenco V, Khafif A.
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Shabbir Akhtar

Department of Surgery, The Aga Khan University and Hospital, Karachi, Pakistan.

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