Mediastinal dissection--1976: indications and newer techniques.

Head and neck neoplasms may invade the mediastinum by direct extension or metastases to the tracheoesophageal or jugulo-subclavian lymph nodes. The clavicles and manubrium are a barrier to adequate resection in this type of disease. In 1962, the senior author reported six mediastinal dissections for stomal recurrences after laryngectomy. Later techniques for staging the removal of manubrium and clavicles and preparing the regional flaps were devised to avoid major complications arising from operating in this area which usually had prior treatment with radiation and/or surgery. Over 60 transsternal radical neck dissections have been performed in the past 20 years. We have in the past evaluated the morbidity and survivals in stomal cases and present here our revised indications and techniques.