The carotid sheath: An anatomicopathologic study

Background. Recurrences in the neck after neck dissections occur even in previously operated fields. Although the pathogenesis is unclear, it is well established that recurrences commonly occur at the jugular chain of nodes close to the carotid artery. We investigated the carotid sheath as possibly responsible for such regional recurrences. Methods. Patients undergoing therapeutic or elective neck dissections were prospectively enrolled. Following surgery, the carotid sheath was resected throughout its entire length, fixated in formalin, and histologically examined. Results. Pathologic assessment of carotid sheaths harvested from 34 patients who underwent 40 uncomplicated neck dissections revealed fibro-fatty tissue and scarce neutrophilic infiltration in all 40 specimens. Four lymphoid aggregates composed almost exclusively of B cells were found at the carotid bifurcation level in three patients. No cancer cells were detected. Conclusion. The absence of cancer cells in patients with metastatic nodes argues against the need to resect the carotid sheath as part of a routine neck dissection. The occurrence of lymphoid aggregates within it, however, may indicate its participation in the pathogenesis of nodal recurrence following neck dissection.