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Oncological safety of the Hayes-Martin manoeuvre in neck dissections for node-positive oropharyngeal squamous cell carcinoma

  • F Riffat (a1), M A Buchanan (a1), A K Mahrous (a1), B M Fish (a1) and P Jani (a1)...



The Hayes-Martin manoeuvre involves ligation of the posterior facial vein and superior reflection of the investing fascia below the mandible to preserve the marginal mandibular nerve. The peri-facial nodes thus remain undissected. We perform this manoeuvre routinely during modified radical neck dissection for metastatic oropharyngeal squamous cell cancer. Here, we review the oncological safety and marginal mandibular nerve preservation rates of this manoeuvre from 2004 to 2009.


Retrospective review of the head and neck oncology database (2004–2009) at Addenbrooke's Hospital, Cambridge, UK, a tertiary referral centre for head and neck oncology.


Thirty-four patients underwent modified radical neck dissection for metastatic oropharyngeal squamous cell carcinoma. The primary tumour included the tonsil in 19 cases, base of tongue in 10 and posterior pharyngeal wall in 5. The neck nodal status was N1 in 4 cases, N2a in 11, N2b in 10, N2c in 4 and N3 in 5. All patients had adjuvant radiotherapy. Median follow up was four years (range, two to five). No peri-facial nodal region recurrences were seen. Four patients had temporary marginal mandibular nerve weakness; beyond two months, no weakness was seen.


In neck dissections for oropharyngeal squamous cell carcinoma, the marginal mandibular nerve and accompanying facial nodes can be safely preserved without oncological risk using the Hayes-Martin manoeuvre.


Corresponding author

Address for correspondence: Mr F Riffat, Senior Head and Neck Fellow, Department of Otolaryngology Head and Neck Surgery, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, UK E-mail:


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1Shah, JP. Patterns of cervical node metastasis from squamous cell carcinoma of the upper aerodigestive tract. Am J Surg 1990;160:405–9
2Shingaki, S, Takada, M, Sasai, K. Impact of lymph node metastasis on the pattern of failure and survival in oral carcinomas. Am J Surg 2003;185:278–84
3Shepard, PM, Olson, J, Harari, PM, Leverson, G, Hartig, GK. Therapeutic selective neck dissection outcomes. Otolaryngol Head Neck Surg 2010;142:741–6
4Koch, WM. Complications of surgery in the neck. In: Eisele, D, ed. Complications in Head and Neck Surgery, 2nd edn.Philadelphia, USA: Mosby Elsevier, 2009;2:439–65
5Di Nardo, LJ. Lymphatics of the submandibular space: an anatomic, clinical and pathological study with applications to floor of mouth carcinoma. Laryngoscope 1998;108:206–13
6Medina, JE. Neck dissection. In: Bailey, B, ed. Otolaryngology - Head and Neck Surgery. Philadelphia: Lippincott-Raven, 1998;1563–93
7Fischer, JE. Mastery of Surgery, 5th edn.Philadelphia, USA: Lippincott William Wilkins, 2007;1:286–9
8National Comprehensive Cancer Network: NCCN Guidelines. In: [14th June 2011]
9Sheahan, P, Colreavy, M, Toner, M, Timon, C. Facial node involvement in head and neck cancer. Head Neck 2001;26:531–6
10Gray, H. Anatomy of the Human Body, 26th edn.Philadelphia: Lea and Febiger, 1954
11Lim, YC, Lee, JS, Choi, EC. Perifacial lymph node metastasis in the submandibular triangle of patients with oral cavity and oropharyngeal squamous cell carcinoma with clinically node-positive neck. Laryngoscope 2006;116:2187–90
12Batstone, MD, Scott, B, Lowe, D, Rogers, SN. Marginal mandibular nerve injury during neck dissection and its impact on patient perception of appearance. Head Neck 2009;31:673–8
13Møller, MN, Sørensen, CH. Risk of marginal mandibular nerve injury in neck dissection. Eur Arch Otorhinolaryngol 2012;269:601–5
14Seppalainen, AM, Soderolm, AL, Lindqvis, C. Neuromuscular dysfunction after surgical treatment of oral cancer. Electromyogr Clin Neurophysiol 1995;35:4551
15Hanna, L, Crosby, T, Macbeth, F. Practical Clinical Oncology. Cambridge: Cambridge University Press, 2008;106–8
16Barrett, A, Dobbs, J, Morris, S, Roques, T. Practical Radiotherapy Planning. Oxford, UK: Hodder Arnold, 2009;4:134–45



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