Aim(s): Neck arteries dissection (carotid and vertebral) is known as one of the causes of stroke which often occurs after a neck trauma. This study was a case report of a vertebral artery dissection in a young woman following a neck manipulation in order to treat a headache by a local therapist. Patient Information: The patient was a 27 years old woman with migraine headaches who referred to the emergency department with decreased consciousness. The results of metabolic and infectious examinations were negative, therefore brain imaging of the patient was considered. Initial CT scan had no particular finding. Therefore, MRI was performed which indicated acute infarction in the pons and cerebellum. MR angiography was performed to examine the vascular system of the brain which determined the left vertebral artery occlusion. CT angiography recognized vertebral artery dissection as the cause of vascular occlusion. Detailed examination of the patient's condition revealed that the patient experienced the neck manipulation by a local therapist before referral to the hospital. Conclusion: Neck arteries dissection as one of the causes of neurologic deficit and decrease the level of consciousness should be considered in patients with minor or severe trauma. After this diagnosis, the existence of trauma in the patient examination should be considered. Trauma may have a legal significance.

Introduction: During functional neck dissection, the surgeon tries to preserve the internal jugular vein (IJV); however, the incidence of its narrowing or obstruction following modified radical neck dissection (MRND) or selective neck dissection (SND) varies between 0% and 29. 6%. The most distressing complication of IJV thrombosis (IJVT) is pulmonary embolism. This study aimed to evaluate the incidence of IJVT following selective or modified radical neck dissection. Materials and Methods: In this study, 109 neck dissections were performed with the preservation of the IJV on 89 patients from March 2011 to December 2012 in the Cancer Institute of Imam Khomeini Hospital Complex, Tehran, Iran. Ultrasound evaluation of the IJV was performed in the early postoperative period and three months after the surgery. Results: The study population consisted of 62 male and 27 female patients with a mean age of 57+17. 57 years. Ultrasound evaluation of the IJV among the participants (109 veins) indicated thrombosis in nine veins (8. 25%) in the early postoperative period, four of which remained thrombotic and without flow three months after the surgery. Moreover, 96. 33% of the IJVs were patent with a normal blood flow three months after the neck dissection. Among the evaluated IJVs, the only factor that showed a significant association with IJVT was the incidence of postoperative complications, including hematoma and seroma (P=0. 01). Conclusion: It seems that the most important factor for the prevention of the IJVT is a meticulous surgery and surgical complication avoidance during neck dissection.

Background: Traditionally, the excision of submandibular glands has been a standard procedure during neck dissection. The excision of submandibular glands can decrease the patient's quality of life. However, recent investigations have suggested the absence of lymphoid tissue and a low susceptibility to metastasis in these glands, thereby negating the imperative for their removal.Methods: In the current investigation, a retrospective analysis of medical records and imaging data about patients afflicted with head and neck cancer and subjected to Level I neck dissection was undertaken. This study aimed to assess the involvement and metastatic potential of submandibular glands and also the relationship between the grade of tumor and involvement of lymph nodes.Findings: The findings revealed a lack of involvement of submandibular glands, thereby substantiating the rationale for preserving these glands during neck dissection. Preserving these glands can provide a better quality of life for patients. The study found no significant correlation between tumor grade and lymph node involvement.Conclusion: Involvement of submandibular glands in head and neck cancers is rare and preserving these glands can be considered during surgery.

Background and Objectives: Cancers of head and neck can cause functional, cosmetic, social and economic problems. Neck metastasis From upper aerodigestive tract cancers is a concern in management. The aim of this study is to determine the occult neck metastasis from squamouse cell carcinoma (SCC) of upper aerodigestive tract and its proper management. Materials and Methods: This is a cross - sectional study on patients with squamouse cell carcinoma of upper aerodigestive tract that hospitalized in departments of Otolaryngology Head and Neck Surgery and general surgery in Amir-alam referral hospital of Tehran University of Medical Scienses. Results: 33% of patients were involved in occult metastasis in cervical lymph nodes. In 60% of patient’s more than one lymph node were involved. In the majority of patients tumor was in T2 stage. The occult neck metastasis was 24.6% in SCC of oral cavity, 44.7% in SCC of larynx and 42% in SCC of hypopharynx. There was significant relation between occult neck metastasis and T stage of tumor.Conclusion: when the risk of occult neck metastasis is higher than 20% and the primary site treatment modality is surgery elective neck dissection is indicated. In extracapsular spread or involvment of multiple lymph nodes with microscopic metastsis the postoperative radiation to neck is necessary.

Background: In head and neck cancer patients, diagnosis of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymph node (N0) remains controversial. While routine neck treatment would result in overtreatment in many patients, observation may delay the diagnosis and decrease the patients’ survival. Objectives: To gain insights into the unclear questions regarding the value of diagnostic modalities in patients with N0 neck, this study was designed to compare the diagnostic efficacy of palpation, ultrasonography (US) and ultrasound-guided fine needle aspiration (USGFNA) in detecting cervical lymph node metastasis.Patients and Methods: Forty-two patients with head and neck cancer who underwent US and USGFNA prior to elective neck dissection were studied. Histopathologic findings of the neck specimens were compared with each diagnostic technique.Results: Of the 53 neck dissection specimens, histopathology showed metastases in 16 cases. The overall accuracy of USGFNA, US and palpation was 96%, 68% and 70%, respectively. The specificity of USGFNA was superior to palpation and US alone. USGFNA had the highest sensitivity, predictive value and accuracy in detecting cervical metastases compared with other performed tests. Conclusions: In our study, USGFNA was superior to palpation and US in detecting metastasis in clinically negative necks. This method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis, but further investigations are needed before this modality could be considered as an alternative to elective neck dissection.

Introduction: Anatomical variations of the neck muscles have previously been reported, involving in particular the omohyoid and sternothyroid muscles. We herein report a novel variant neck muscle found during a routine surgical procedure. Case Report: A 63-year-old women underwent a pelvi-mandibulectomy with bilateral neck dissection for a squamous cell carcinoma of the floor of mouth pT3N1. On the right neck dissection, the present peculiar muscle was discovered. It was located in the lateral region of the neck, deeply to the sternocleidomastoid muscle and caudally to the hyoid bone. It took origin from the sixth cervical vertebrae’, s transverse process and attached caudally to the middle third of the clavicular bone, after having passed superficially to the omohyoid muscle’, s intermediate tendon. Conclusions: Neck muscles are important during head and neck surgery due to their significance as surgical landmarks and their relationship with noble vessels. Being aware of possible variant that can alter classical anatomical reference points is important to prevent iatrogenic trauma.

Backgrond: Papillary Thyroid Carcinoma (PTC), unlike other cancers, is completely curable if the treatment begins at early stages of the disease, before any metastasis occurs. One of the common places that the cancer may invade is the neck lymph nodes. On this basis, many surgeons suggest prophylactic central neck lymph nodes dissection in such patients, but others do not agree because of the risks that may exceed the benefits of this approach. Despite the presence of several studies in this regard, the debate is still ongoing. Therefore, the present study was conducted to examine the effect of prophylactic central neck lymph node dissection on preventing recurrence in patients with PTC.Materials & Methods: In the current clinical trial, a total of 122 patients with PTC were enrolled who were categorized in two equal 61-patient groups, with (case) and without (control) prophylactic central neck lymph nodes dissection. Short-term (up to 10 days post-operation) and long-term (six months post-operation) consequences were compared between the two groups. None of the patients had evidences of central cervical lymph node involvement before operation. The results were analyzed using Chi-square and t-test.Results: Both groups were comparable in terms of age (mean, 46.1 years in the case group and 45.8 years in the control group) and sex (10 males in the case group and 11 males in the control group). In the case group, there were 16 patients (26.2%) with pathology-proven central cervical lymph node involvement. Serum calcium level dropped more significantly in the case group immediately after the surgery, but returned to a comparable level with that in the controls at the six-month time-point. Comparison of cases and controls showed no significant difference in terms of vocal cord involvement (4.9% vs.3.3%, respectively; p=0.50), recurrent mass (0% vs.3%, respectively; p=0.49) or new regional lymphadenopathy (1.6% vs.7%, respectively; p=0.37). None of the patients in the study deceased nor had recurrent nerve injury.Conclusion: Prophylactic central cervical lymph node dissection has no significant effect on the occurrence rate of short-term/long-term complications of surgery in patients with PTC.

Introduction: Tonsillectomy is one of the most common procedures performed by otolaryngologists. Intraoperative bleeding is a significant problem, which requires hemostasis and causes prolonged operative time. Several different techniques are used to perform this operation. The Ligasure Vessel Sealing System (LVSST) has been widely used in head and neck surgery because of its effectiveness and safety.Methods: This project was conducted at the department of otolaryngology of Besat Hospital, Hamadan, Iran. In this double-blinded clinical trial, 82 subjects, who were candidates for tonsillectomy and qualified in eligible criteria, were randomly assigned to 2 group of 41 subjects. Surgery was performed using Lvsst for one group and cold knife dissection for the other group. Measured outcomes for efficacy and adverse effect were intraoperative blood loss, operation time, post-operative pain in visual analogue scale, and post-operative bleeding for28 days after surgery. The SPSS 16 software was used for data analysis.Results: Method of LVSST was significantly better than CKT in operation time and bleeding on the first day after surgery, yet, postoperative blood loss in the first week after surgery in LVSST group was significantly higher than the CKT group. Severity of sore throat after surgery with Ligasure was higher than CKT the group, however the difference was not significant. Intraoperative bleeding in the LVSST group was significantly lower than that of the CKT group (P=0.000).Conclusion: The results of this study showed that the prevalence of respiratory symptoms LVSST was better than CKT in intraoperative (not post-operative) blood loss and operation time, yet there was no difference regarding postoperative pain. For workers with a history of allergies, this ratio is higher.