European Journal of Molecular & Clinical Medicine

Background: Surgery is the most well established mode of initial definitive
treatment for a majority of oral cancers. Over the past few decades, the surgical technique
of neck dissection has evolved from Radical neck dissection to Modified radical neck
dissection and then to Selective Neck Dissection.
Objectives: The main purpose of this research is to evaluate the incidence of pathologic
incursion of the carotid sheath, when noticed grossly uninvolved while doing surgery in
the patients with neck dissection for head and neck squamous cell carcinoma (HNSCC).
Methods: 80 neck dissections will be performed. Carotid Sheath will be removed separately
and methodically evaluated by well experienced head and neck pathologists by performing
hematoxylin and Eosin staining and Immunohistochemistry Analysis with Markers like
Pancytokeratin and CD34 for tumour infiltration and the occurrence of lymphatic 
tissue. Hence, if found negative than it will strongly indicate that we can modify the neck
dissections limiting upto the level of carotid sheath.
Results: Carotid Sheath is not grossly involved, removal of Carotid Sheath is not
recommended. Histologically Carotid Sheath may harbour dilated lymphatic vessels,
lymphocytes aggregates and neutrophils. Carotid Sheath, however, would not harbour any
metastatic tumour emboli from primary Oral Squamous Cell Carcinoma.
Conclusion: Not only for surgical safety but also for the shield it provides post operatively
against adjuvant radiation therapy and any infection in neck and even trickling of saliva
down the neck postoperatively by protecting vital structures it encases like Common carotid
artery, Vagus Nerve and Internal jugular vein. So far there is paucity of data in presence
of metastatic involvement of carotid Sheath. This study will give basis for preservation of
Carotid sheath during neck dissection which will reduce postoperative morbidities in head
and neck squamous cell carcinoma patients.