Related Experiment Video
Updated: Jun 23, 2026
Modified Radical Neck Dissection for Cervical Metastasis
Published on: February 20, 2026
Image-guided surgery in an occult neck metastasis
Kathleen Mierzwa1, Andreas Mueller
1Department of Otorhinolaryngology/Plastic Surgery, SRH Wald-Klinikum Gera gGmbH, Gera, Germany.
Background:
We report a case of a squamous cell carcinoma of the right tonsillar region with 5 metastatic lymph nodes and a retropharyngeal metastasis, the latter detected in the preoperative MRI scan.
Methods And Results:
The treatment consisted of excision of the tumor in the oral cavity and the bilateral neck dissection. Despite careful exploration, a retropharyngeal metastasis was not identifiable during this procedure. This failure encouraged us to use navigation-guided surgery in a second step. The difficulty in using navigation in soft tissue of the neck is the fixation of the neck. Therefore, a thermoplastic head mask, normally indicated in radiation therapy, was used for both the preoperative CT and navigation-guided surgery. The retropharyngeal metastasis was successfully excised with this method.
Conclusion:
This is the first reported attempt to use navigation-guided surgery in the soft tissue of the neck. It reveals new opportunities for navigation in the future.
