Surgical technique—unwrapping the neck node levels around a sternocleidomastoid muscle bar: A systematic way of performing (modified) radical neck dissection

Aim Description of a systematic approach to the neck for removal of lymph node bearing tissues in levels I–V. Method A (modified) radical neck dissection is divided in three steps: (1) Dissection of levels I–IV, (2) dissection of level V and (3) transection of SCM bar and finalisation of the dissection. The sternocleidomastoid muscle (SCM) is used as a ‘bar’, around which the different neck levels can be systematically unwrapped, warranting permanent cranio-caudal tension of the neck specimen, while anatomical relations remain intact. Results In a group of 115 (modified) radical en bloc neck dissections with or without post-operative radiotherapy 10% regional recurrences, 2% post-operative chylous fistulas and <5% post-operative wound infections occurred. The overall 5 years survival was 45% (95% confidence interval: 36–54%). Conclusion A systematic unwrapping of lymph node levels around the sternocleidomastoid bar provides a reliable systematic method for performing (modified) radical neck dissections without a negative influence on clinical outcome.