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Is Dissection of the Apex of Level V Necessary in Mucosal Squamous Cell Carcinoma of the Head and Neck?

Marc Hamoir, MD; Gauthier Desuter, MD; Vincent Grégoire, MD,PhD; Hervé Reychler, MD,DDS; Philippe Rombaux, MD; Benoît Lengelé, MD,PhD

Arch Otolaryngol Head Neck Surg. 2002;128:1381-1383.

In 1991, the Committee for Head and Neck Surgery and Oncology of the American Academy of Otolaryngology–Head and Neck Surgery proposed to define the anatomic boundaries between the lymph node levels in the neck, as initially described by the Memorial Sloan-Kettering Cancer Center (New York, NY). Recently, radiological parameters have been outlined to identify boundaries between various neck levels. The lymphatics of the posterior triangle of the neck are gathered in level V, recently subdivided into 2 subgroups: level Va and level Vb. The superior boundary of level Va is defined by the apex of the convergence of the sternocleidomastoid muscle and trapezius muscle. Based on anatomic evidence and surgical experience, we advocate the subdivision of level Va into 2 sections: the apex of level Va or level Vas (superior) and level Vai (inferior), demarcated by the lower two thirds of the spinal accessory nerve. Dissection of level Vas is not necessary in most head and neck cancers but should be considered only in selected skin cancer of the posterior cephalic area (retroauricular region, occipital scalp).

From the Departments of Otolaryngology–Head and Neck Service (Drs Hamoir, Desuter, and Rombaux), Radiation Oncology (Dr Grégoire), Oral and Maxillofacial Surgery (Dr Reychler), and the Plastic and Reconstructive Surgery and Human Anatomy Unit (Dr Lengelé), Université Catholique de Louvain, St Luc University Hospital and Cancer Center, Head and Neck Oncology Program, Brussels, Belgium.

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