Central Neck Dissection

The central neck is defined as the anatomic region encompassed by the hyoid bone superiorly, the carotid arteries laterally, the prevertebral fascia posteriorly, and the suprasternal notch inferiorly. Thyroid cancer can metastasize to the central neck lymph nodes, necessitating a therapeutic central neck dissection which involves removing all fibrofatty node-bearing tissue from the central neck. Patients should undergo ultrasound of the central and lateral neck, and fine needle aspiration of lateral neck suspicious for lymphadenopathy is identified to determine the need for central neck dissection. The surgical risks involve injury to the recurrent laryngeal nerve and hypoparathyroidism secondary to inadvertent removal or devascularization of the parathyroid glands. If the parathyroid glands are found intraoperatively to be devascularized or inadvertently removed, autotransplantation should be performed once the gland is confirmed to be parathyroid tissue and not a lymph node harboring metastatic thyroid cancer. A central neck dissection is usually performed at the same time as a total thyroidectomy, but occasionally is performed in the reoperative setting for recurrent thyroid cancer in a patient that has already undergone thyroidectomy.