Selective Neck Dissection: CT and MR Imaging Findings
Patricia A. Hudginsa,
Todd T. Kingdomb,
Mark C. Weisslerc and
Suresh K. Mukherjid
a Department of Radiology, Emory University School of Medicine, Atlanta, GA
b Department of Otolaryngology, University of Colorado Health Sciences Center, Denver, CO
c Department of Otolaryngology, Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
d Department of Radiology, University of Michigan School of Medicine, Ann Arbor, MI
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FIG 1. Squamous cell carcinoma, supraglottic larynx, treated with bilateral SND.
A, Preoperative axial postcontrast enhanced 3-mm-thick CT image. Note the mass on the laryngeal surface of the suprahyoid epiglottis, and the small bilateral level IIA nodes. Both were positive on pathologic examination, despite the small size. The SCM muscles are normal in contour and symmetric.
B, Postoperative 3-mm-thick CT image, same patient, following supraglottic laryngectomy and bilateral SND (levels II, III, and IV on the left and I–IV on the right). There is marked decrease, bilaterally, in the fat about the carotid sheath, and the SCM muscles appear short and thick. On the right side, the undersurface of the SCM abuts the lateral aspect of the paraspinal muscles. Both internal jugular veins are patent and are flattened laterally (arrows) when in direct contact with the undersurface of the sternocleidomastoid muscles.
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FIG 2. Patient has undergone resection of oropharyngeal squamous cell carcinoma, and left SND (levels I, II, and III). Postoperative CT scan of 3-mm-section thickness was obtained several months following surgery. There is marked paucity of fat beneath the left SCM muscle, and the muscle lies directly on top of the internal jugular vein.
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FIG 3. Patient treated for right tonsillar cancer with right SND (levels II, III, and IV). The right SCM muscle (thin arrow) is atrophic, thinned and flat compared with the left side, and there is decreased fat beneath the muscle. There is marked atrophy of the right infrahyoid strap muscles (thick arrow). Note lack of opacification of the right IJV, presumably due to thrombosis. The right true vocal cord palsy is unrelated to the surgery.
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