Neck dissection has been evolving since 1906 when George Crile described the so-called radical neck dissection. From the very beginning it became evident to many surgeons that the procedure was adequate for advanced disease in the neck but was too aggressive for early N stages. Thus, to avoid the unnecessary removal of some neck structures, several conservation procedures were designed since the 1920s.
This book will present the evolution of these "less than radical'' operations from two different perspectives: the American and the Latin. The reason for this duality must be sought in the evolution of neck dissection. Over the years, this surgery has experienced the influence of two simultaneous tendencies, separated only by a language factor. This factor has produced a misunderstanding of ideas leading to a mismatch between concepts and surgical techniques.
The concept of a functional approach to the neck, materialized in the so-called functional neck dissection, has not been fully apprehended in the English literature. As a result, a new original idea has been identified as just another technical modification, which is included in a vast classification as just one more item.
This book tries to differentiate between conceptual approaches and surgical techniques. The former constitute keystones in the evolution of scientific knowledge. The latter are only technical variations of a standard procedure, designed to solve the problem using the most effective approach. Functional neck dissection belongs to the first group because it reflects a new original approach to the problem of lymph node metastases in head and neck cancer. On the other hand, selective neck dissections should be included within the group of surgical techniques because they share with functional neck dissection the same rationale and indications. Selective neck dissections constitute only technical variations of the functional concept, designed to fit the operation to the patient on a more individualized basis. The problem of functional and selective neck dissection will thus be addressed in this book from a different, nonconventional perspective: functional refers to a concept, and selective refers to surgical techniques included within this concept.
However, we do not intend this book to be merely a summary of the history and philosophy of neck dissection. We would like to bring this book to the medical shelves, not to the libraries of history. Therefore, we provide a detailed description of the anatomical basis and surgical technique of the functional approach to the neck. And by ''functional approach to the neck'' we mean any type of neck dissection that uses the basic principles of fascial dissection. Fascial spaces and barriers of the neck hold the rationale for functional neck dissection. This idea will be repeatedly emphasized throughout the text.
Finally, we include a comprehensive list of technical hints and pitfalls that the authors have learned through the years. These details, along with the answers to the most frequently asked questions regarding functional neck dissection, complete the contents of this book and contribute to the book's general purpose.
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