Central neck dissection

The central compartment of the neck, also known as level VI, is bounded by the carotid arteries laterally, the hyoid bone superiorly, and the suprasternal notch or innominate artery inferiorly. Papillary thyroid cancer, derived from follicular cells, and medullary thyroid cancer, derived from parafollicular cells, commonly metastasize to the cervical lymph nodes. Therapeutic central neck dissection for papillary thyroid cancer is clearly indicated, while routine prophylactic central neck dissection for papillary thyroid cancer is controversial. Pre-operatively, all patients should undergo comprehensive neck ultrasound with fine needle aspiration biopsy of any suspicious lymph nodes. To perform a central neck dissection, the patient is positioned supine with the neck extended. Total thyroidectomy is performed in the standard fashion. The thin fascial layer overlying the recurrent laryngeal nerve is incised and the nerve then dissected away from the fibrofatty lymph node-bearing tissue of the paratracheal space extending from the point of the nerve's insertion into the criocthyroid muscle superiorly to the thoracic inlet inferiorly and between the carotid arteries laterally. The pretracheal tissue is dissected inferiorly to the suprasternal notch. The lower parathyroid gland is frequently devascularized during this procedure and should be autotransplanted if its blood supply is in doubt. Drains are not usually necessary. Patients are usually discharged home the following day.