Functional and Selective Neck Dissection


Functional and Selective Neck Dissection

Second Edition

Javier Gavilán, MD

Professor and Chairman

Department of Otorhinolaryngology

La Paz University Hospital

Madrid, Spain

Alejandro Castro, MD

Chief of Head and Neck Surgery Division

Department of Otorhinolaryngology

La Paz University Hospital

Madrid, Spain

Laura Rodrigáñez, MD

Head and Neck Surgeon

Department of Otorhinolaryngology

La Paz University Hospital

Madrid, Spain

Jesús Herranz, MD

Chief of Section

Department of Otorhinolaryngology

Complejo Hospitalario Universitario A Coruña

A Coruña, Spain

136 illustrations


Stuttgart • New York • Delhi • Rio de Janeiro

A Tribute to Osvaldo Suárez and César Gavilán

The following are the words of César Gavilán in the previous edition of this book:

The memory of Osvaldo Suárez, along with our gratitude, is still alive in the minds of those of us who had the privilege to meet him. We still remember his amazing surgical expertise, based on years of anatomical dissections. On the last day of his visit to Madrid he started a last case shortly before leaving for the airport. As the time of his plane’s departure approached we offered to continue the case on our own. He gently declined saying that he could finish the case if he could operate without explaining the surgical details. We accepted his offer to see the scalpel in his hands literally fly over the surgical field in a way we had never seen before. The operation was completed in 20 minutes: 20 minutes of the cleanest, most effective surgery that we had ever seen.

He was not only a superb surgeon but also a great person with his colleagues and, especially, with his patients. His idea of function preservation always went hand in hand with a clear demarcation of priorities. His motto, ‘‘A life without voice is much better than a voice without life,’’ stresses the importance of defining priorities in the field of laryngeal cancer treatment. We would like this book to be a tribute to his memory, often forgotten in the world of neck dissection.

César Gavilán passed away suddenly in 2004. We dedicate this second edition to his memory. Functional neck dissection is here because he was humble, visionary and dynamic. He accepted to see the surgery performed by one of the attendants to his course in Córdoba (Argentina) and immediately realized that the operation could be a major improvement for patients with laryngeal cancer. One year later Osvaldo Suárez spent two weeks in Madrid and functional neck dissection began to spread among European otorhinolaryngologists. He was also a great surgeon and teacher. His dedication to show the concept and surgical technique of functional neck dissection constitute the basis of the knowledge included in this book. Osvaldo Suárez and César Gavilán: two great men, two excellent surgeons. The origin of a new approach to neck dissection.

Dr. Osvaldo Suárez (left) and Dr. César Gavilán (right) at La Paz University Hospital in Madrid, Spain: 1969.


The adverse prognostic impact of cervical lymph node metastases in head and neck cancer was appreciated by several pioneering surgeons in the first half of the 19th century. To address this problem, many attempts were made by Maximillian Von Chelius, J. C. Warren, Richard Von Volkmann, Theodor Kocher, and other noted persons to excise these metastatic lymph nodes; all unsuccessfully. At the turn of the 19th century, Sir Henry Trentham Butlin, in his Hunterian lecture, emphasized the need to excise upper cervical lymph nodes in the surgical treatment of tongue cancer. Franciszek Jawdynski from Poland has been credited with publishing the first report on neck dissection, in the Polish gazetta. However, the credit for reporting a systematic technique of excision of cervical lymph nodes from all levels in the neck for treatment of cancers of the head and neck goes to George Crile Sr., who published in the Journal of the American Medical Association in 1906 details of the operation of ‘‘radical neck dissection’’ based on his personal experience of 132 operations. Hayes Martin later popularized the operation and established it as the standard of surgical care for cervical lymph-node metastasis, and it remained in vogue for nearly three quarters of the 20th century. Although the operation was oncologically effective and considered the gold standard, it also caused significant esthetic and functional morbidity.

The authors of the second edition of this book bring a perspective from the experience of several generations of Latin surgeons largely influenced by the pioneering work of Oswaldo Suárez from Argentina and subsequent adoption of Suárez’s system by César Gavilán in Spain and Ettore Boca in Italy, for the surgical management of cervical lymph nodes in head and neck cancer. The philosophy, goals, and principles of functional neck dissection and the technical details of respecting fascial planes form the backbone of the entire concept of functional and selective neck dissections. As the authors point out, selective neck dissections are a logical sequel to the concept of functional neck dissection, based on the knowledge of patterns of neck metastases. The concept of cervical lymphatics contained within the fascial compartments of the neck, initially developed and applied to surgical techniques by Dr. Suárez, is appropriately credited in this work. Subsequent promulgation of his concepts and techniques in Europe by César Gavilán and Ettore Bocca led to the accumulation of significant surgical experience, particularly in cancers of the larynx, to justify the validity of the concept and its surgical application with convincing outcomes. The authors propose functional neck dissection as a concept and not a modification of the standard radical neck dissection. To that end, the historical perspective detailed in this textbook is impressive.

Understanding of the patterns of cervical lymph-node metastasis has further advanced the concept of functional neck dissection to the development and clinical applicability of selective neck dissections. Thus, the varieties of selective neck dissections currently in vogue are called extensions of the concept, and a logical extension of the concept of functional neck dissection, as proposed in this book.

The authors are to be commended for putting together a fine contribution to the literature in the field of head and neck surgery and oncology. This book is a classic tour through the history of surgical management of neck metastasis and is a meticulous and outstanding treatise on the anatomy of the fascial planes in the neck, the cervical lymphatics, well illustrated with beautiful anatomic drawings by Laura Rodrigáñez and the technical aspects of the operation, its complications and their management. The years of experience amassed by the authors is reflected in the chapter on “Hints and Pitfalls.” The addition of a chapter on frequently asked questions and answers is a refreshing nuance, which gives the impression of an interactive dialogue between the reader and the authors.

This opus from the surgical dynasty of the Gaviláns, now with support from Jesús Herranz and enhanced by contributions from Alejandro Castro and Dr. Rodrigáñez, representing the new generation of head and neck surgeons in Spain, is truly a monumental work on the history, development, philosophy, practice, and outcomes of functional neck dissection.

Jatin P. Shah, MD, PhD, DSc, FACS, FRCS(Hon), FRCSDS(Hon), FDSRCS(Hon), FRCSI(Hon), FRACS(Hon)

E W Strong Chair in Head and Neck Oncology

Professor of Surgery

Memorial Sloan Kettering Cancer Center

New York, New York

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May 3, 2020 | Posted by in ANESTHESIA | Comments Off on Functional and Selective Neck Dissection
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