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Neck dissection procedure

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Neck dissection
Neck dissection
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Neck dissection procedure

  1. 1. NECK DISSECTION PROCEDURE JAMEEL KIFAYATULLAH
  2. 2. Neck dissection procedure • Utility incision is marked
  3. 3. Landmarks • Mastoid process • Inferior border of the mandible • The clavicle • Midline chin
  4. 4. Incision • Incision centered in a skin crease between the inferior border of mandible and the clavicle
  5. 5. Marking of external jugular vein • The external jugular vein is marked because this structure is preserved for lateral microvascular anastomosis and it commonly serves as a landmark for locating the greater auricular nerve, which usually lies in the same plane within 1 cm posterior to the external jugular vein
  6. 6. markings
  7. 7. anaesthesia • the skin is infiltrated with epinephrine containing local anesthetic.
  8. 8. Elevation of subplatysmal flaps • the skin incision is made and carried through the platysma. Subplatysmal flaps are elevated to the level of the inferior border of the mandible superiorly and the clavicle inferiorly • Once the flaps are elevated, they are retracted with stay sutures or hooks
  9. 9. Freeing of SCM • For a radical neck dissection or modified radical neck dissection with sacrifice of the SCM, the SCM is freed from its attachments to the mastoid and clavicle
  10. 10. LYMPH NODES DISSECTION • Then, level V lymph nodes are dissected and the spinal accessory nerve is preserved if possible. Level V lymph nodes along with the SCM, level II, III, and IV lymph nodes are dissected in an anterior direction.
  11. 11. Lymph nodes dissection • During dissection of levels III and IV, care is taken to avoid injury to the lymphatic ducts, phrenic nerve, vagus nerve, or brachial plexus
  12. 12. Internal jugular vein • If the IJV is to be sacrificed, it is ligated proximally and distally and then dissected in continuity with the specimen. If the IJV is to be left in place, careful removal of the fascia and lymphatic tissue circumferentially around the IJV is performed while avoiding excessive torsion on the vein. Branches emanating from the vein on the anterior and medial surface are ligated and divided
  13. 13. Dissection of specimen • The entire specimen is dissected further off of the carotid artery, taking care not to excessively thin the carotid artery or injure the vagus nerve.
  14. 14. Level I node dissection • Next, level I lymph nodes are dissected starting in level IA and moving posterior • The facial nerve is identified and dissected free of the fascia and retracted superiorly; this allows complete dissection of level IB and the perifacial lymph nodes while protecting the facial nerve from inadvertent injury
  15. 15. Level 1 dissection • The mylohyoid muscle is identified and retracted anteriorly, and the submandibular duct, lingual nerve, and hypoglossal nerves are identified. The duct is ligated and divided, and the gland along with the nodal contents of the submandibular triangle is then delivered inferiorly.
  16. 16. Delivery of specimen • By this point, the specimen is held only by some attachments immediately anterior to the carotid artery. These attachments are carefully divided taking care not to injure branches of the external carotid artery. Once this is complete, the specimen is delivered from the neck.
  17. 17. Selective neck dissection • In a selective neck dissection, once the subplatysmal flaps are elevated, the fascia over the SCM is incised and the SCM is retracted laterally to expose level II, III, and IV lymph nodes • These levels are then dissected from the fascia over the splenius capitus and levator scapulae muscles, taking care not to injure the spinal accessory nerve, phrenic nerve, brachial plexus, or lymphatic ducts. The specimen is brought anterior as the dissection proceeds
  18. 18. Selective neck dissection • Dissection of the IJV proceeds with care not to injure the vein, the vagus nerve, or carotid artery • Dissection of level I proceeds in the same manner as for a modified radical or radical neck dissection.
  19. 19. Selective neck dissection • Once the specimen is removed, it is oriented for the pathologist and the levels are marked with skin staples or sutures • Drains are placed in the wound and the wound is closed, reapproximating platysma with Vicryl suture and skin with staples.
  20. 20. Levels of neck • Level I lymph nodes are located superior to the hyoid bone and the digastric muscle to the inferior border of the mandible
  21. 21. Levels of neck • Level 1 further subdivided into submental (IA) and submandibular (IB) groups • Submental group lymph nodes are located anterior to the anterior belly of the digastric muscle and cephalad to the hyoid bone up to the inferior border of the mandible
  22. 22. SUBMENTAL( IA) GROUP
  23. 23. Submandibular (IB) Group Lymph nodes located posterior to the anterior belly of the digastric muscle and superior to the anterior and posterior bellies of the digastric muscle up to the inferior border of the mandible are the submandibular group
  24. 24. Level II lymph nodes • Level II lymph nodes are located around the upper portion of the IJV and the upper portion of the spinal accessory nerve extending from the base of the skull downwards to the bifurcation of the carotid artery.
  25. 25. Level 3 lymph nodes • Level III lymph nodes are around the middle portion of the IJV starting from the inferior border of level II extending downwards to the omohyoid muscle.
  26. 26. Neck levels
  27. 27. Level IV group • Level IV lymph nodes are the lower portion of the IJV extending from the inferior border of level III downwards to the clavicle
  28. 28. Levels of neck • The posterior triangle group or level V is bound by the triangle formed by the clavicle, posterior border of the SCM, and the anterior border of the trapezius muscle .
  29. 29. Level VI AND VII • The central compartment of the neck is broken down into level VI and VII. Level VI lymph nodes are from the hyoid bone to the suprasternal notch and between the medial borders of the carotid sheath. Level VII, the superior mediastinal group, are the lymph nodes located in the anterior mediastinum extending from the innominate artery inferiorly to the suprasternal notch.

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