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Image‐guided surgery in an occult neck metastasis
Author(s) -
Mierzwa Kathleen,
Mueller Andreas
Publication year - 2010
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.21118
Subject(s) - medicine , metastasis , occult , radiology , neck dissection , soft tissue , surgery , head and neck squamous cell carcinoma , retropharyngeal space , radiation therapy , head and neck cancer , carcinoma , cancer , computed tomography , pathology , alternative medicine
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. © 2009 Wiley Periodicals, Inc. Head Neck, 2010