Neck Dissection Manual

Dietmar Thurnher has been Professor of ENT Diseases at Graz University, Austria since March 2015. He was previously Deputy Head of the Department of Otolaryngology, Head & Neck Surgery at Vienna Medical University. His research priorities concern the prognosis and treatment of cancer in the head and neck region, and especially translational research and the development of new therapeutic molecules. He is the author/co-author of several textbooks, including the German-language title HNO-Heilkunde. Ein symptomorientiertes Lehrbuch (ISBN 978-3-211-88984-8).

• 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.