Practical Guide to Neck Dissection

116 Pages·2007·7.72 MB·English

by  Lucioni M.

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Marco Lucioni
Practical Guide to Neck Dissection
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Marco Lucioni
Practical Guide
to Neck Dissection
Forewords by
Italo Serafini, Jatin P. Shah, Jesus Medina,
Wolfgang Steiner, Antonio Antonelli
With 135 Figures, Mostly in Colour
123
Marco Lucioni, MD
Via G. Leopardi 9
31029 Vittorio Veneto, Italy
Library of Congress Control Number: 2007924718
ISBN 978-3-540-71638-9 Springer Berlin Heidelberg NewYork
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Foreword (I)
It was three o’ clock in the afternoon: time for that “… all those who studied surgery should be-
anatomy class. A badly lit room, a caretaker to come learned in operations and particularly in
collect tips, and a single lecturer for 30 students. the anatomy of the human body …” Mondino dei
The material on which to study practical anat- Liuzzi, author in 1316 of the treatise Anathomia,
omy consisted of a humerus, a femur, and an en- introduced cadaveric dissection into the univer-
tire decomposing human forearm with skeletized sity teaching curriculum in Bologna. The chief
muscles and tendons, reduced to shreds by previ- Council of the Serenissima Republic in Venice
ous inexperienced dissectors. Then, 2 years later decreed that every year a number of corpses
at midday, I found myself in a pathologic anat- should be dissected “propter urbis honorem civi-
omy amphitheater with 300 students. An empty umque salutem”.
corpse lay on the distant dissection table with However, the “anatomy century” was un-
various removed organs lined up by its side. The doubtedly the 16th century, with its Renaissance
lecturer was giving his last class for the course anatomists. The most outstanding figure in the
and gratefully addressed the deceased, “for do- scientific revolution of that period was clearly
nating his body to the progress of science”. These Andreas Vesalius from Brussels (1514–1564)
are my recollections as a student of medicine 35 with his De Humani Corporis Fabrica. Prevented
years ago. Yet Padua was an important University, from practicing dissection at the University of
one of the most ancient, most prestigious univer- Leuven, Vesalius came to Padua where, despite
sities in Europe! These experiences go back many his very young age, the Serenissima government
years, but I do believe the situation has changed appointed him to the chair of anatomy in virtue
very little since then. of his extensive knowledge on the subject and
These were my thoughts 15 years ago when corpse-dissecting skills.
I was invited to direct a neck dissection course Five and a half centuries later, we were to
in the corpse at the Vrije Universiteit Brussel. To make the same journey as Vesalius, only in the
prepare the course, after 30 years’ experience in opposite direction. Prevented by law and custom
neck surgery, I went back to, or rather, I found from holding a course on dissection in Italy, we
myself for the very first time dissecting a cadaver. left the land of the Serenissima in the direction
I would like to thank all colleagues at the Uni- of Brussels, where a modern university organiza-
versity of Pavia for lending me their dissection tion provided us with all the necessary technical
theater. It was a stimulating, highly positive expe- equipment and 15 cadavers. We armed ourselves
rience, enabling my coworker and me to broaden with our long and inveterate experience in neck
and develop our knowledge of neck anatomy surgery and our more recent know-how in ca-
and its border areas. While we iconographically daveric neck dissection with related iconography.
documented the various cervical regions and dis- When, after the second “Andreas Vesalius course”,
section planes, our thoughts turned to past expe- as we call them, Dr. Marco Lucioni, my faithful
riences in this type of activity. coworker in the preparation and conduction of
Anatomic dissection for research purposes these scientific-teaching ventures, expressed the
dates back to the Egyptians in Alexandria, but desire to produce a volume on anatomic neck
was prohibited in the Western world for many dissection techniques, based on our experience,
centuries by Jewish and Christian religious cul- I did not hesitate to encourage him. I then enthu-
ture. A decree was passed in the Kingdom of siastically observed the text being drawn up and
Sicily in 1231 by Frederick II of Swabia, stating divided into the various chapters and figures.
Now the volume by Lucioni is complete and I trust my favorable, but not impartial, judg-
ready to go to press. I find it a very carefully ment will encourage those who wish to browse
prepared, comprehensive, well-illustrated work, through, and hopefully read it.
constituting an essentially practical, valid ref-
erence tool that freshens up notions in normal Italo Serafini
and topographical neck anatomy and a precious Chairman Emeritus
guide for anyone practicing anatomic neck dis- ENT Department
section in the corpse. Vittorio Veneto, Italy
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Foreword (II)
The first report on neck dissection can be traced describes anatomic structures in the cadaver un-
to Richard Volkmann in 1882; however it was der four different headings: the parotid region,
Franciszek Jawdynski who described the tech- submandibular triangle, the lateral neck, and the
nique of the operation in 1888. Henry But- median cervical region. Each section describes
lin proposed an upper neck dissection for the anatomy in the superficial layer as well as the
treatment of tongue cancer at the turn of the deep layer. Clinical implications of the anatomic
nineteenth century; however, George Crile is structures in therapeutic interventions are high-
credited for the first systematic report on clas- lighted with bullet points indicating “take home
sical radical neck dissection over 100 years ago, messages” and “core messages”. Each section be-
based on his personal experience of 132 cases. gins with a diagram of the anatomic structures
Since then, neck dissection has remained the important in that region, followed by cadaver
mainstay of surgical treatment of metastatic cer- dissection, highlighting the salient features of
vical lymph nodes from mucosal and cutaneous each step of the operation. The book is comple-
carcinomas of the head and neck. Increasing mented by a DVD showing video clips of neck
experience with this surgical technique and im- dissection in the cadaver, further familiarizing
proved understanding of biological progression the reader with step-by-step anatomic structures
of metastatic cancer to cervical lymph nodes led encountered during various types of neck dissec-
to the development of numerous modifications tions. The author has also thus included various
in neck dissection, with the aim of retaining modifications in neck dissection, which are cur-
oncologic efficacy but reducing the morbidity rently employed in clinical practice.
of the operation. Thus, Oswaldo Suarez initially For the student of head and neck surgery, this
proposed a modified neck dissection that was book would be a valuable resource to his or her
subsequently popularized by Ettore Bocca in personal library, since it is a stepwise approach
English literature. Further modifications in neck to understanding the anatomy of the neck and
dissection were proposed by Allando Ballantyne its importance in performing a systematic, safe,
and others during the latter half of the twentieth and effective surgical procedure for excision of
century. The systematic classification of various cervical lymph nodes, either involved or at risk
types of neck dissections and its applications by metastatic cancer from primary tumors in the
have been proposed and popularized by the head and neck. The photographic reproduction is
American Academy of Otolaryngology/Head crisp and clear, both in the cadaver dissections as
and Neck Surgery, and these are currently em- well as in the DVD. Highly accurate and effective
ployed in clinical practice worldwide. works such as this are crucial to further solidify
Dr. Marco Lucioni is to be complimented on the surgical prowess of head and neck surgeons
putting together this outstanding piece of work of the future.
initially stimulated by Italo Serafini. The book is
prepared from sequential photographs of cadaver Jatin P. Shah
dissections of systematic steps at understand- Professor and Chairman
ing the topographical anatomy of various layers Memorial Sloan-Kettering Cancer Center
of tissues in the neck. The author systematically New York, New York, USA
Foreword (III)
Through many years of collecting textbooks of documentation of surgical anatomy of the dif-
anatomy, I have cherished the magnificent de- ferent regions of the neck, the parotid, and the
scriptions of anatomy provided by the likes of larynx. As such, it would be treasured by medical
Testut, Latarjet, and Rouviere. As an academic students of anatomy, who will find in it a clear,
head and neck surgeon practicing and teaching almost three-dimensional depiction of the differ-
in North America, I have frequently struggled ent muscular, vascular, and neural structures of
not only translating them into English, but also the neck. It would be equally valued by students
making these descriptions intuitively usable by of otolaryngology and head and neck oncologic
students of head and neck surgery. surgery for they will find that the complex rela-
A few years ago, I was invited to Italy to lec- tionships of these anatomic structures are shown
ture on selective neck dissections. As a memento, in a manner and sequence similar to what they
I was given a copy of foul proof of Practical Guide would encounter during different surgical proce-
to the Neck Dissection by Marco Lucioni. I was dure in the neck, the thyroid, the parotid gland
thrilled to encounter in this book the anatomy of and the larynx. Teachers of anatomy and of sur-
the neck depicted in a way that only a surgeon gery will also find it valuable since it will enable
can, when his or her knowledge and expertise them, as it has often enabled me, to illustrate for
are combined with the talents of a good artist students, residents, and fellows important ana-
and a good photographer. tomic structures and their relationships in a way
As I reflect on my reactions when I read the that is not always possible in the classroom or in
book, I predict that a potential reader, who picks the operating theater.
up this book out of curiosity and begins leafing This book will find and keep a preferential
through it, will at first be intrigued, if nothing place in the library of many for it represents what
else, by the exceptional quality of the drawings we always hope for in a book of this kind, but
and by the clarity of the photographs of anatomic rarely get.
dissections. The reader will then feel compelled to
study these illustrations and the text that accom- Jesus E. Medina
panies them and will, shortly thereafter, come to Professor and Chairman
the realization that this is not just a collection of University Health Sciences Center
beautiful illustrations; it is, rather, an insightful Oklahoma City, Oklahoma, USA
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Foreword (IV)
It is my great pleasure to write a preface for this and precise surgical dissections, while preserv-
anatomical surgical compendium for head and ing structure and function. The excellent illustra-
neck surgery edited by Marco Lucioni. tions of the complex topographical relationships
I have known Lucioni for many years and have between muscles, blood vessels, nerves, and lym-
had the opportunity in his courses and during phatic structures in detailed photographs will al-
visits to Vittorio Veneto to become acquainted low the surgeon to proceed confidently even in
with and to appreciate his surgical talents. the difficult and risk-fraught dissection of the
Someone with such extensive experience and head and neck region.
deftness in head and neck surgery is predestined This book is a valuable contribution and is to
to edit an anatomically detailed, illustrated pre- be highly recommended as a guide for head and
sentation of operations of the neck, the larynx, neck surgeons in the Italian tradition of anatomy
and the salivary glands. and surgery.
The impressive, excellently photographed
intraoperative sites together with the informa- Wolfang Steiner
tive schematic drawings will be of help to ENT Professor and Chairman
specialists, laryngologists, and head and neck Georg-August Universität
surgeons in performing anatomically oriented Göttingen, Germany