The Neck Dissection Manual

Part 1 Introduction.- Definition and types of neck dissection.- Pre-operative investigations.- Operative set-up.- Recommended instruments. Part 2 Selective Neck Dissection.- Positioning of the patient.- Marking of the skin incision.- Skin incision and exposure of platysma.- Elevation of cranial and caudal subplatysmal flaps.- Identification of the marginal ramus of the facial nerve.- Identification of the anterior belly of the digastric muscle.- Dissection of the tissue along the mandible and litigation of the facial artery and vein.- Identification and dissection of the mylohyoid muscle.- Identification of the lingual nerve.- Identification and ligation of the submandibular duct.- Identification of the hypoglossal nerve.- Finalization of level I dissection.- Dissection of the investing fascia along the anterior border of the sternocleidomastoid muscle.- Elevation of the sternocleidomastoid muscle.- Identification and dissection of the accessory nerve.- Identification ofthe digastric muscle.- Identification of the internal jugular vein.- Completion of the dissection of the accessory nerve.- Dissection of level 2b.- Identification of the hypoglossal nerve.- Definition of the inferior border of the dissection.- Definition of the lateral border of the dissection.- Dissection of the tissue lateral to the internal jugular vein.- Dissection of the tissue off the internal jugular vein.- Dissection of the tissue medial to the internal jugular vein.- En bloc removal of tissue.- Irrigation and hemostasis.- Insertion of suction drains.- Wound closure in multiple layers.- Skin incision and dissection of the platysma.- Elevation of cranial and caudal subplatysmal flap.- Dissection of the anterior border of the sternocleidomastoid muscle.- Elevation of the sternocleidomastoid muscle.- Identification of the accessory nerve at levels II and V.- Complete elevation of the sternocleidomastoid muscle.- Identification of the anterior border of the trapezius muscle.- Complete dissection of the accessory nerve.- Identification of the digastric muscle and internal jugular vein.- Dissection of level 2b.- Identification of the marginal ramus of the facial nerve.- Identification of the anterior belly of the digastric muscle.- Dissection of the tissue along the mandible and ligation of the facial artery and vein.- Identification and dissection of the mylohyoid muscle.- Identification of the lingual nerve.- Identification and litigation of the submandibular duct.- Identification of the hypoglossal nerve.- Finalization of level I dissection.- Identification of the internal jugular vein above the clavicle.- Identification of the vagus and phrenic nerves.- Definition of the inferior and deep border.- Horizontal dissection above the clavicle.- Identification of the brachial plexus.- Dissection of lymphoid tissue from lateral to medial part I.- Dissection of lymphoid tissue from lateral to medial part II.- Dissection of lymphoid tissue from lateral to medialpart III.- Dissection of lymphoid tissue from lateral to medial part IV.- En bloc removal of specimen.- Irrigation and Hemostasis.- Insertion of suction drains.- Wound closure in multiple layers.- Part 3 Radical Neck Dissection.- Skin incision and dissection of the platysma.- Elevation of cranial and caudal subplatysmal flap.- Identification of the trapezius muscle.- Resection of the cranial insertion of the SCM muscle.- Resection of the caudal insertion of the SCM muscle.- Identification and ligation of the internal jugular vein cranially.- Identification and ligation of the internal jugular vein caudally.- Identification of the marginal ramus of the facial nerve.- Identification of the anterior belly of the digastric muscle.- Dissection of the tissue adjacent to the mandible in the facial artery and vein.- Identification and dissection of the mylohyoid muscle.- Identification of the lingual nerve.- Identification and ligation of the submandibular duct.- Identification of the hypoglossal nerve.- Finalization of level I dissection.- Definition of the inferior and deep border.- Horizontal dissection above the clavicle.- Dissection of lymphoid tissue from lateral to medial part I.- Dissection of lymphoid tissue from lateral to medial part II.- Dissection of lymphoid tissue from lateral to medial part III.- En bloc removal of specimen.- Rinsing and coagulation.- Insertion of suction drainage.- Wound closure in three layer.- References.