Radical Neck Dissection - NEET PG High-Yield Notes

ls /home/daytona/workspace/ 2>/dev/null || mkdir -p /home/daytona/workspace/neck…

mkdir -p /home/daytona/workspace/neck-dissection && ls /home/daytona/workspace/n…

~/neck-dissection/chart.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE"; // 13.3" x 7.5"
pres.title = "Neck Dissection Comparison Chart";

// ─── COLOR PALETTE ───────────────────────────────────────────────
const C = {
  bg:        "0D1B2A",  // Deep navy (dominant)
  panel:     "122236",  // Slightly lighter navy for cards
  rnd:       "C0392B",  // Bold red for RND
  rndLight:  "1A1010",  // Dark red tint bg
  mrnd:      "E67E22",  // Orange for MRND
  mrndLight: "1A1308",
  snd:       "27AE60",  // Green for SND
  sndLight:  "0C1A10",
  gold:      "F0C040",  // Accent/highlight
  white:     "FFFFFF",
  offWhite:  "E8EDF3",
  muted:     "8FA3B8",
  border:    "1E3A5A",
};

// ═══════════════════════════════════════════════════════════════════
// SLIDE 1 - TITLE SLIDE
// ═══════════════════════════════════════════════════════════════════
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  // Main title
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    x: 0.8, y: 1.7, w: 11.5, h: 1.1,
    fontSize: 52, bold: true, color: C.white,
    fontFace: "Arial", charSpacing: 4, margin: 0,
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  // Subtitle
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    fontSize: 28, bold: false, color: C.gold,
    fontFace: "Arial", charSpacing: 2, margin: 0,
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  // Tagline
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    fontSize: 14, color: C.muted, fontFace: "Arial", italic: true, margin: 0,
  });

  // Three colored pills for RND / MRND / SND
  const pills = [
    { label: "RND", color: C.rnd, x: 0.8 },
    { label: "MRND", color: C.mrnd, x: 2.35 },
    { label: "SND", color: C.snd, x: 4.1 },
  ];
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    });
  });

  // Source note
  s.addText("Source: Cummings Otolaryngology | Scott-Brown's | Sabiston Surgery", {
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    fontSize: 9, color: C.muted, fontFace: "Arial", italic: true, margin: 0,
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}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 2 - MAIN COMPARISON TABLE (Wide)
// ═══════════════════════════════════════════════════════════════════
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    valign: "middle", charSpacing: 2, margin: 0,
  });

  // Table data
  const hdr = { fill: { color: "1A3050" }, color: C.white, bold: true, fontSize: 10, fontFace: "Arial", align: "center", valign: "middle" };
  const rndH = { fill: { color: C.rnd }, color: C.white, bold: true, fontSize: 11, fontFace: "Arial", align: "center", valign: "middle" };
  const mrndH = { fill: { color: "B06010" }, color: C.white, bold: true, fontSize: 11, fontFace: "Arial", align: "center", valign: "middle" };
  const sndH = { fill: { color: "1E7A44" }, color: C.white, bold: true, fontSize: 11, fontFace: "Arial", align: "center", valign: "middle" };

  const rowStyle = (rndColor, mrndColor, sndColor) => [rndColor, mrndColor, sndColor];

  const cell = (txt, clr, extraOpts = {}) => ({
    text: txt,
    options: {
      fill: { color: clr },
      color: C.offWhite,
      fontSize: 9.5,
      fontFace: "Arial",
      valign: "middle",
      align: "left",
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      ...extraOpts,
    }
  });

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      bold: true,
      fontFace: "Arial",
      valign: "middle",
      align: "left",
      margin: [3, 6, 3, 6],
    }
  });

  const R = "161010"; // Dark red row bg
  const O = "161008"; // Dark orange row bg
  const G = "0C180E"; // Dark green row bg
  const D = "0F1C2E"; // Default dark navy row

  const tableRows = [
    // Header row
    [
      { text: "PARAMETER", options: { ...hdr, fill: { color: "0D2240" } } },
      { text: "RND\nRadical Neck Dissection", options: rndH },
      { text: "MRND\nModified Radical ND", options: mrndH },
      { text: "SND\nSelective Neck Dissection", options: sndH },
    ],
    // Levels dissected
    [
      paramCell("Levels Dissected"),
      cell("I – V (ALL levels)", R),
      cell("I – V (ALL levels)", O),
      cell("Specific levels based on primary site\n(e.g., I-III, II-IV, VI)", G),
    ],
    // Non-lymphatic structures
    [
      paramCell("Non-Lymphatic\nStructures"),
      cell("ALL THREE removed:\n• Spinal Accessory Nerve (SAN)\n• Internal Jugular Vein (IJV)\n• Sternocleidomastoid (SCM)", R),
      cell("1 or more PRESERVED:\n• Type I: SAN preserved\n• Type II: SAN + IJV preserved\n• Type III: SAN + IJV + SCM\n  (= Functional ND)", O),
      cell("ALL THREE preserved:\n• SAN intact\n• IJV intact\n• SCM intact", G),
    ],
    // Indications
    [
      paramCell("Indications"),
      cell("• Extensive nodal metastases\n• Extracapsular spread (ECS)\n• Tumor fixed to / invading SAN or IJV\n• NOT for N0 disease", R),
      cell("• Gross nodal disease NOT invading\n  non-lymphatic structures\n• Multiple levels involved\n• Preferred over RND when SAN is free", O),
      cell("• Clinically node-negative (N0) or early\n  nodal disease at predictable levels\n• Based on primary tumor location\n• Same therapeutic value as RND/MRND\n  for selected patients", G),
    ],
    // Primary site mapping (SND specific)
    [
      paramCell("SND Subtypes by\nPrimary Site"),
      cell("N/A", R, { align: "center" }),
      cell("N/A", O, { align: "center" }),
      cell("Oral cavity → Supraomohyoid (I-III)\nLarynx/Oropharynx/Hypopharynx → Lateral (II-IV)\nThyroid/Larynx/Midline → Anterior (VI)\nSkin/Scalp → Posterolateral (IIA, IIB, III, IV, V)", G),
    ],
    // Morbidity
    [
      paramCell("Key Morbidity"),
      cell("• Shoulder drop (trapezius palsy — SAN loss)\n• Facial/cerebral venous congestion (IJV loss)\n• Neck contour deformity (SCM loss)\n• Bilateral IJV: raised ICP!", R),
      cell("• Reduced vs. RND\n• Shoulder morbidity if SAN sacrificed\n• Bilateral IJV loss: raised ICP\n  (avoid simultaneous bilateral IJV sacrifice)", O),
      cell("• Minimal — all 3 structures preserved\n• Residual disease risk if wrong levels\n  selected\n• Often combined with adjuvant RT", G),
    ],
    // Contraindications / not indicated
    [
      paramCell("NOT Indicated For"),
      cell("• N0 (node-negative) disease\n• Nodes not fixed to non-lymphatic\n  structures", R),
      cell("• Nodes directly infiltrating/fixed\n  to SAN or IJV\n  (→ upgrade to RND)", O),
      cell("• Extensive multinodal disease\n• ECS present\n• Not for nodes fixed to non-\n  lymphatic structures", G),
    ],
    // Recurrence rates
    [
      paramCell("Regional Recurrence\nRate (Therapeutic)"),
      cell("Varies by ECS:\n• Macro ECS: ~44%\n• Micro ECS: ~25%\n• Multi-level +nodes: 71%", R),
      cell("0 – 20%\n(with/without adjuvant RT)", O),
      cell("N0 neck: 4–6%\nN+ (single node, no ECS): ~10%\nN+ (multiple/ECS): ~24%\n→ Adjuvant RT reduces to ~15%", G),
    ],
  ];

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// ═══════════════════════════════════════════════════════════════════
// SLIDE 3 - INDICATIONS DEEP DIVE (3 COLUMNS)
// ═══════════════════════════════════════════════════════════════════
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  s.addText("INDICATIONS — DETAILED BREAKDOWN", {
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    fontSize: 16, bold: true, color: C.gold, fontFace: "Arial", valign: "middle", charSpacing: 2, margin: 0,
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  const cards = [
    {
      title: "RND  –  Radical Neck Dissection",
      color: C.rnd,
      darkBg: "1A0A08",
      x: 0.15,
      sections: [
        {
          heading: "Primary Indication",
          body: "Extensive cervical lymph node metastases with EXTRACAPSULAR SPREAD (ECS) — the #1 indication",
        },
        {
          heading: "Specific Criteria",
          bullets: [
            "Tumor directly invading or fixed to SAN (CN XI)",
            "Tumor invading or encasing the Internal Jugular Vein",
            "Multiple matted nodes across several levels",
            "Salvage surgery after failed RT/CRT",
            "Extended RND: + skin, hypoglossal nerve, carotid",
          ],
        },
        {
          heading: "NOT Indicated",
          bullets: [
            "N0 (clinically node-negative) disease",
            "Nodes not fixed to non-lymphatic structures",
          ],
        },
        {
          heading: "Prognostic Note",
          body: "ECS is the strongest prognostic factor. Macroscopic ECS → 44% recurrence. Adjuvant RT strongly recommended post-RND.",
        },
      ],
    },
    {
      title: "MRND  –  Modified Radical ND",
      color: C.mrnd,
      darkBg: "1A1005",
      x: 4.55,
      sections: [
        {
          heading: "Primary Indication",
          body: "Grossly visible multilevel nodal disease NOT directly infiltrating or fixed to non-lymphatic structures (SAN, IJV, SCM)",
        },
        {
          heading: "Types & When",
          bullets: [
            "Type I (SAN preserved): SAN not involved, IJV/SCM invaded",
            "Type II (SAN+IJV preserved): IJV uninvolved but SCM invaded",
            "Type III / Functional ND: all 3 structures free — best functional outcome",
            "Sacrifice of 1-2 structures allowed if grossly invaded intraop",
          ],
        },
        {
          heading: "Key Point",
          body: "Cannot justify sacrificing SAN if it is not involved, since hypoglossal + vagus nerves (in equal proximity) are routinely spared.",
        },
        {
          heading: "Bilateral Caution",
          body: "Simultaneous bilateral IJV sacrifice = severe facial edema + raised ICP. Avoid or stage procedures.",
        },
      ],
    },
    {
      title: "SND  –  Selective Neck Dissection",
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      darkBg: "081508",
      x: 8.95,
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          heading: "Primary Indication",
          body: "Patients at risk for EARLY / predictable lymph node metastases based on primary tumor site",
        },
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          heading: "Level Selection by Site",
          bullets: [
            "Oral cavity → I, II, III (Supraomohyoid)",
            "Oropharynx / Larynx / Hypopharynx → II, III, IV (Lateral)",
            "Thyroid / Trachea / Larynx (midline) → VI (Anterior/Central)",
            "Posterior scalp / Cutaneous → IIA, IIB, III, IV, V (Posterolateral)",
          ],
        },
        {
          heading: "Basis (Shah's Study)",
          body: "Oral cavity mets → Levels I-III. Pharynx/larynx → Levels II-IV. When positive nodes found outside these — disease also present in the at-risk zone.",
        },
        {
          heading: "Equivalent Efficacy",
          body: "Studies show SND has same therapeutic value as RND/MRND for selected patients. Combined with adjuvant RT for N+ disease.",
        },
      ],
    },
  ];

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// ═══════════════════════════════════════════════════════════════════
// SLIDE 4 - COMPLICATIONS + QUICK MEMORY AIDS
// ═══════════════════════════════════════════════════════════════════
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    fontSize: 16, bold: true, color: C.gold, fontFace: "Arial", valign: "middle", charSpacing: 2, margin: 0,
  });

  // ── COMPLICATIONS TABLE (left 60%) ──
  s.addText("KEY COMPLICATIONS OF NECK DISSECTION", {
    x: 0.15, y: 0.73, w: 7.8, h: 0.3,
    fontSize: 10.5, bold: true, color: C.gold, fontFace: "Arial", margin: 0,
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      { text: "Details / Key Fact", options: { fill: { color: "1A3050" }, color: C.white, bold: true, fontSize: 9, fontFace: "Arial", align: "center", valign: "middle" } },
      { text: "Rx", options: { fill: { color: "1A3050" }, color: C.white, bold: true, fontSize: 9, fontFace: "Arial", align: "center", valign: "middle" } },
    ],
    [
      { text: "⚠ Shoulder Drop\n(Trapezius palsy)", options: { fill: { color: "200808" }, color: C.rnd, bold: true, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
      { text: "SAN (CN XI) sacrifice in RND. #1 morbidity. Cannot abduct arm >90°", options: { fill: { color: "1A1010" }, color: C.offWhite, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
      { text: "Physiotherapy", options: { fill: { color: "141010" }, color: C.muted, fontSize: 8.5, fontFace: "Arial", valign: "middle", align: "center" } },
    ],
    [
      { text: "Chylous Fistula", options: { fill: { color: "141A10" }, color: C.snd, bold: true, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
      { text: "Level IV dissection. Left side >> Right. ~1.9–3% incidence. Thoracic duct injury", options: { fill: { color: "0F1A0F" }, color: C.offWhite, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
      { text: "MCT diet, octreotide; surgery if >300 mL/day", options: { fill: { color: "0C1510" }, color: C.muted, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
    ],
    [
      { text: "Marginal Mandibular\nNerve Injury", options: { fill: { color: "12180A" }, color: C.mrnd, bold: true, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
      { text: "Most common nerve injured. Facial droop at corner of mouth. Level I-II dissection", options: { fill: { color: "141808" }, color: C.offWhite, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
      { text: "Observation; often temporary", options: { fill: { color: "101408" }, color: C.muted, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
    ],
    [
      { text: "Greater Auricular\nNerve Injury", options: { fill: { color: "141418" }, color: "A0A0D0", bold: true, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
      { text: "C2-C3 origin; exits at Erb's point. Sensory loss over parotid/ear. Up to 36% temp injury rate", options: { fill: { color: "0F1018" }, color: C.offWhite, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
      { text: "Usually temporary", options: { fill: { color: "0C0E15" }, color: C.muted, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
    ],
    [
      { text: "Carotid Artery\nBlowout (CBS)", options: { fill: { color: "200808" }, color: C.rnd, bold: true, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
      { text: "RARE but FATAL. Risk: prior RT, fistula, advanced disease. 50% mortality. Proximal to bifurcation", options: { fill: { color: "1A0808" }, color: C.offWhite, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
      { text: "Endovascular embolization/stenting; emergency surgery", options: { fill: { color: "150808" }, color: C.muted, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
    ],
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      { text: "Bilateral IJV Sacrifice", options: { fill: { color: "200808" }, color: C.rnd, bold: true, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
      { text: "Massive facial edema + raised ICP. AVOID simultaneous bilateral IJV ligation", options: { fill: { color: "1A0808" }, color: C.offWhite, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
      { text: "Stage procedures; consider MRND to preserve 1 IJV", options: { fill: { color: "150808" }, color: C.muted, fontSize: 8.5, fontFace: "Arial", valign: "middle" } },
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  // ── RIGHT COLUMN: MEMORY AIDS ──
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    ["#1 morbidity of RND =", "Shoulder drop (SAN sacrifice)"],
    ["Most common nerve injured =", "Marginal mandibular branch (CN VII)"],
    ["Functional ND =", "MRND Type III (all 3 structures preserved)"],
    ["Bilateral IJV sacrifice →", "Raised ICP + massive facial edema"],
    ["Chyle leak side =", "Left >> Right (thoracic duct)"],
    ["Chyle leak Rx >300 mL/day =", "Surgical ligation"],
    ["Jugulo-digastric node =", "Tonsillar node (Level II)"],
    ["Oral cavity SND =", "Supraomohyoid (I-III)"],
    ["Larynx/Oropharynx SND =", "Lateral (II-IV)"],
  ];

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    s.addText([
      { text: line[0] + " ", options: { bold: true, color: C.gold, fontSize: 8.5 } },
      { text: line[1], options: { bold: false, color: C.offWhite, fontSize: 8.5 } },
    ], {
      x: rx + 0.12, y: yy, w: 4.6, h: 0.26,
      fontFace: "Arial", valign: "middle", margin: 0, wrap: true,
    });
  });

  // ERB'S POINT BOX
  s.addShape(pres.shapes.RECTANGLE, {
    x: rx, y: 4.03, w: 4.85, h: 1.55,
    fill: { color: "0A1A28" }, line: { color: C.gold, pt: 1.2 },
  });
  s.addText("ERB'S POINT — Key Anatomy", {
    x: rx + 0.08, y: 4.08, w: 4.7, h: 0.28,
    fontSize: 9.5, bold: true, color: C.gold, fontFace: "Arial", margin: 0,
  });
  s.addText([
    { text: "Location: ", options: { bold: true, color: C.mrnd } },
    { text: "Junction of upper 1/3 & lower 2/3 of posterior SCM border\n", options: { color: C.offWhite } },
    { text: "Nerves emerging at Erb's Point:\n", options: { bold: true, color: C.mrnd } },
    { text: "• Spinal Accessory Nerve (SAN / CN XI)\n• Greater Auricular Nerve (C2-C3)\n• Lesser Occipital Nerve\n• Transverse Cervical Nerve\n• Supraclavicular Nerve", options: { color: C.offWhite } },
  ], {
    x: rx + 0.1, y: 4.38, w: 4.68, h: 1.15,
    fontSize: 8.5, fontFace: "Arial", valign: "top", wrap: true, margin: 0,
  });

  // THORACIC DUCT BOX
  s.addShape(pres.shapes.RECTANGLE, {
    x: rx, y: 5.65, w: 4.85, h: 0.9,
    fill: { color: "0A1A10" }, line: { color: C.snd, pt: 1.2 },
  });
  s.addText("THORACIC DUCT — Key Point", {
    x: rx + 0.08, y: 5.68, w: 4.7, h: 0.25,
    fontSize: 9.5, bold: true, color: C.snd, fontFace: "Arial", margin: 0,
  });
  s.addText("Opens at junction of LEFT internal jugular vein + LEFT subclavian vein.\nMust be protected during LEFT Level IV neck dissection.\nRight-sided equivalent (right lymphatic duct) is smaller but also at risk.", {
    x: rx + 0.1, y: 5.95, w: 4.68, h: 0.58,
    fontSize: 8.5, color: C.offWhite, fontFace: "Arial", valign: "top", wrap: true, margin: 0,
  });

  s.addText("Cummings Otolaryngology | Scott-Brown's | Sabiston Surgery", {
    x: 0.2, y: 7.35, w: 12.9, h: 0.15,
    fontSize: 7.5, color: C.muted, fontFace: "Arial", italic: true, margin: 0,
  });
}

// ═══════════════════════════════════════════════════════════════════
// WRITE FILE
// ═══════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/neck-dissection/RND_vs_MRND_vs_SND.pptx" })
  .then(() => console.log("✅ PPTX written successfully"))
  .catch(e => console.error("❌ Error:", e));

cd /home/daytona/workspace/neck-dissection && node chart.js 2>&1