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Lecturer to Trace Approaches to Functional Neck Dissection

Eugene N. Myers, MD International Lecture on Head and Neck Cancer
10:00 – 11:00 am
Monday
Room E450A

There are multiple approaches to neck dissection, and all are variations on two basic operations: radical and functional. Most head and neck surgeons opt for some sort of selective approach based on individual patient anatomy with the goal of preserving as much function as possible. A largely unknown approach to functional neck dissection (FND) developed in the 1960s can improve both surgical and functional outcomes.

Javier Gavilán, MD

“The concept is to follow the planes of the fascial tissue that covers all of the important structures of the neck, the muscles, nerves, veins, and arteries as you dissect the neck,” said Javier Gavilán, MD, professor and chair of otorhinolaryngology at La Paz University Hospital in Madrid, Spain. “If you follow the road map that is the fascial tissue of the neck, you can remove lymphatic tissue and tumor tissue, and preserve the structure of the neck. Most head and neck surgeons do something that is similar, but the simple concept behind functional dissection has almost never been understood.”

Dr. Gavilán will explore the history, anatomic concepts, and surgical techniques applicable to FND when he delivers his lecture, “Functional Neck Dissection: The Great Unknown.” Understanding the theory of FND can improve practice and outcomes.

Neck dissection began as a radical procedure that was described by George Crile, MD, in 1906. By the 1960s, surgeons had begun to question the need for radical dissection of the neck, breast, and other organs, and developed less invasive alternatives.

FND was originally published in the Spanish surgical literature by Osvaldo Suárez, MD, in the early 1960s. An anatomist by training,
Dr. Su
árez recognized that the important structures of the neck were compartmentalized by the fascia. Neck function could be better preserved if the surgeon could remove lymphatic and tumor tissue without violating the fascia surrounding other structures.

“Most head and neck surgeons are doing something similar to FND without knowing the underlying concept,” he said. “The moment you understand why you are doing this and how you can manage the situation by following the road map of the fascia, you will be a better surgeon.”

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