Zusammenfassung
Hintergrund: Die Neck-dissection-Klassifikation gründet maßgeblich auf der Einteilung der Halslymphknoten.
Die Terminologie und anatomische Zuordnung der etwa 300 zervikofazialen Lymphknoten
wurde seit Anfang des 20. Jahrhunderts wiederholt, zum Teil auch grundlegend, verändert.
Methoden: Darstellung der Literaturmitteilungen zur Halslymphknoteneinteilung mit Bezug auf
die Entwicklung der Neck-dissection-Klassifikation. Ergebnisse: Die erste fundierte Nomenklatur der Halslymphknoten geht auf Rouviére (1932) zurück.
Suárez (1963) beschrieb die funktionelle Neck-dissection auf der Basis der faszialen
Kompartmentbildung des Halses. Lindberg (1972) verließ die von Rouviére beschriebene,
überwiegend anatomisch korrelierte Gruppierung der zervikalen Lymphknoten und unterteilte
das lymphonoduläre System auf Grundlage pathophysiologischer Mechanismen. Die dadurch
veränderte Aufmerksamkeit hinsichtlich des in Abhängigkeit der Primärtumorlokalisation
wahrscheinlichen Sitzes okkulter Metastasen öffnete den Weg zur Beschreibung der selektiven
Neck-dissektion. Seit der grundlegenden Arbeit von Shah et al. (1981) gab es eine
Vielzahl mehr oder weniger geringfügiger Veränderungen einzelner Regionen, die wiederum
Basis für neue Neck-dissection-Unterteilungen waren, zuletzt im Jahre 2000 mit der
Neufassung der Neck-dissection-Nomenklatur durch die American Head and Neck Society.
Schlussfolgerung: Die Neufassung der Neck-dissection-Klassifikation kann vorbestehende Kontroversen,
vor allem hinsichtlich einer erleichterten intraoperativen Regionszuordnung einzelner
Lymphknoten und einer vereinfachten Terminologie der selektiven Neck-dissection mindern.
Vor dem Ziel einer unbedingt anzustrebenden Vereinheitlichung der Neck-dissection-Formen
bleibt abzuwarten, ob die Befürworter der funktionellen Neck-dissection nach Suárez
das Ausmaß derselben beim N0-Hals verschiedener Primärtumorlokalisationen überdenken
und sich hierbei an den neu formulierten anatomischen Bezugspunkten orientieren werden.
Historical Outline for the Nomenclature of the Lymph Nodes of the Neck as Basis for
Neck Dissection Classification
Background: The neck dissection classification is based considerably on the organization of the
lymph nodes of the neck. Terminology and anatomical allocation of nearly 300 cervicofacial
lymph nodes repeatedly changed since the beginning of the 20th century. Methods: Analysis of the literature on neck lymph node organization with reference to the
development of the neck dissection classification. Results: The first fundamental nomenclature of the neck lymph nodes is founded on the work
of Rouviére (1932). Suárez (1963) described the functional neck dissection on the
basis of the fascial compartmentalization of the neck. Lindberg (1972) left the predominantly
anatomically correlated grouping of the cervical lymph nodes as described by Rouviére
and divided the lymphatic system of the neck on basis of pathophysiological mechanisms.
The attention regarding the location of occult metastases led to the description of
the selective neck dissection. Since the fundamental work of Shah et al. (1981) there
was a multiplicity of more or less slight changes of the neck node regions. These
changes were again basis for new neck dissection terminologies. A new classification
was introduced in the year 2000 as the revised version of the American Head and Neck
Society. Conclusions: The revised version of the neck dissection classification can reduce former controversies,
particularly regarding an optimized intraoperative allocation of the lymph nodes and
a simplified terminology of the selective neck dissection. With the goal of a standardization
of the neck dissection forms it remains to be seen if the proponents of the functional
neck dissection after Suárez consider the extent of the neck dissection in patients
with N0 neck in favor of the selective neck dissection.
Schlüsselwörter:
Lymphknoten - Hals - Neck-dissection - Klassifikation - Terminologie
Key words:
Lymph node - Neck - Neck dissection - Classification - Terminology
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Prof. Dr. J. A. Werner
Univ.-HNO-Klinik
Deutschhausstraße 3
35037 Marburg
eMail: E-mail: j.a.werner@mailer.uni-marburg.de