[Significance of sternocleidomastoid muscle resection in radical neck dissection]

Surgical therapy of cervical lymph node metastasis is based on their accessibility for en bloc resections. First described by Crile in 1906 as a radical neck dissection, this original approach has since undergone various modifications. This has produced an ongoing controversy with regard to the indications of the individual techniques. In a retrospective study, the data of 438 patients with head and neck malignancies managed at the ENT Department of Hamburg University between 1988 and 1994 were analyzed after surgical treatment of cervical lymph nodes. Results showed that 337 patients (76.9%) required unilateral or bilateral selective neck dissections. In 101 patients (23.1%) in whom a radical neck dissection was performed, the sternocleidomastoid muscle was resected completely. Analysis of these cases showed that intraoperative macroscopic invasion occurred in 12 patients (11.9%) and was confirmed histologically. The vast majority of cases (n = 89; 88.1%) had an intact muscle resected without tumor involvement. Further analysis showed no difference between radically or functionally neck-dissected stage III or IV patients with oral cavity, oropharyngeal, hypopharyngeal and laryngeal carcinomas. On the basis of these findings, resection of the sternocleidomastoid muscle is not mandatory in patients undergoing primary surgery without previous (cervical) radiation and when the muscle is found to be macroscopically intact.