Image-guided surgery in an occult neck metastasis.

Abstract

BACKGROUND:

We report a case of a squamous cell carcinoma of the right tonsillar region with 5 metastatic lymph nodes and a retropharyngeal metastasis, the latter detected in the preoperative MRI scan.

METHODS AND RESULTS:

The treatment consisted of excision of the tumor in the oral cavity and the bilateral neck dissection. Despite careful exploration, a retropharyngeal metastasis was not identifiable during this procedure. This failure encouraged us to use navigation-guided surgery in a second step. The difficulty in using navigation in soft tissue of the neck is the fixation of the neck. Therefore, a thermoplastic head mask, normally indicated in radiation therapy, was used for both the preoperative CT and navigation-guided surgery. The retropharyngeal metastasis was successfully excised with this method.

CONCLUSION:

This is the first reported attempt to use navigation-guided surgery in the soft tissue of the neck. It reveals new opportunities for navigation in the future.

• Authors: Kathleen Mierzwa, Andreas Mueller
• Journal: Head & neck (Head Neck) Vol. 32 Issue 4 Pg. 550-3 (Apr 2010) ISSN: 1097-0347 [Electronic] United States
• PMID: 19405088 (Publication Type: Case Reports, Journal Article)

Topics

• Biopsy, Needle
• Carcinoma, Squamous Cell (pathology, secondary, surgery)
• Follow-Up Studies
• Humans
• Immunohistochemistry
• Lymph Node Excision (instrumentation, methods)
• Lymph Nodes (pathology, surgery)
• Lymphatic Metastasis
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Neoplasm Invasiveness (pathology)
• Neoplasm Staging
• Pharyngeal Neoplasms (diagnosis, secondary, surgery)
• Risk Assessment
• Surgery, Computer-Assisted (methods)
• Tomography, X-Ray Computed (methods)
• Tonsillar Neoplasms (pathology, surgery)
• Treatment Outcome