1. PATHOLOGY OF NECK DISSECTION

2. VIEW FROM DEEP ASPECT OF NECK DISSECTION

3. Lymphatic Regions Region I- submental and submandibular triangles. Ia - submental triangle bound by anterior bellies of digastric and deep by mylohyoid. Ib - submandibular triangle formed by anterior and posterior bellies of digastric and body of mandible

4. Lymphatic Regions Region II, III, IV- nodes associated with IJV within fibroadipose tissue located from posterior border of SCM medial to lateral border of sternohyoid.

5. Lymphatic Regions Region II- upper third including upper jugular, jugulodigastric, and upper posterior cervical nodes. Bound by digastric muscle superiorly and hyoid bone (clinical landmark) or carotid bifurcation (surgical landmark) inferiorly. IIa being nodes in region anterior to spinal accessory nerve and IIb posterior to the nerve.

6. Region III- middle third jugular nodes from inferior border of level II to cricothyroid notch (clinical landmark) or omohyoid muscle (surgical landmark). Region IV- lower third jugular nodes from inferior border of level III to clavicle. Region V- posterior triangle of neck bound by posterior border of SCM, clavicle, and anterior border of trapezius muscle.

7. Lymphatic Regions Level VI- anterior compartment surrounding midline visceral structures from hyoid superiorly to suprasternal notch inferiorly and to medial border of carotid sheath laterally.

8. Resection specimens should be orientated by the surgeon and pinned or sutured to cork or polystyrene blocks. The surgeon should indicate surgically critical margins and identify the general territories of node groups by placing markers such as metal tags or sutures at the centre of each anatomical group.

9. A practical alternative for selective dissections is for the surgeon to separate the node groups, mark the superior margin of each group with a suture, and place each group in a separately labelled container.

10. A radical neck dissection may yield an average of 20 nodes (range 10–30), in the absence of previous chemotherapy or irradiation, although on Occasions 50–100 nodes may be identified. This examination would be expected to include, as a minimum, all palpable nodes greater than 3 mm in diameter. Size of largest metastatic deposit. Note that this is not the same as the size of the largest node. The size of the largest metastasis is a determinant in the TNM staging.

11. The 6th edition of the TNM classification has introduced a category of pN0(i+) for nodes that contain clumps of isolated tumour cells (<0.2 mm) that are usually only detected by immunocytochemistry but may be seen on H&E stained sections Involvement of lymphatic channels in neck is a poor prognostic factor, and may be mentioned in the text of the report Presence or absence of extra-capsular rupture and the node level(s) with this feature. Extracapsular spread should be recorded as present or not identified

12. If there is obvious metastatic disease with fusion (matting) of lymph nodes, record: a) the level(s) of nodes involved by the mass b) the maximum size c) an estimate of the number of nodes that might be involved in the mass.

13. A practical approach is to regard any tumour nodule in the region of the lymphatic drainage as a nodal metastasis, and to only diagnose discontinuous extension of a carcinoma within 10 mm of the primary carcinoma and where there is no evidence of residual lymphoid tissue.