Wednesday, May 11, 2016

ENT Procedure 16 radical neck dissection

Radial Neck Dissection
Objective
In cases of cancer of head and neck:
   Excision of cervical lymph node and adjacent muscular and vascular structures.
Position
Supine.
Anesthesia
General.
Procedure
   1.  Incision (Y, double, T, parelle-transverse, Z) in the lateral neck usually beneath the jaw to the supraclavicular region.
   2.  Skin flaps are mobilized.
   3.  The external jugular vein is severed.
   4.  The deep cervical fascia is incised (including some cuta­neous nerve branches).
   5.  The sternoclavicle origins of the sternomastoid muscle are divided.
   6.  The internal jugular vein is isolated and divided.
   7.  The omohyoid muscle is transected.
   8.  Fatty tissues bearing lymph nodes are dissected from underlying structures in continuity.
   9.  The insertion of the sternomastoid muscle is divided.
10.  The lower pole of the parotid gland removed, no injury to branches of the facial nerve.
11.  The facial artery and vein are divided, and the submaxillary gland and proximal end of the internal jugular vein are divided.
12.  The tissue bloc is then excised.
13.  The accessory nerve is preserved on the left, the thoracic duct is protected.
14.  The flaps are closed over suction drains.
15.  A moderate pressure dressing is applied.
Instruments
   Minor procedure set
   Thyroid set
   Tracheostomy set
   Extra mosquito clamps (24)
   Extra towel clips (8)
   Right angle clamps (finely pointed)
   Basin set
   Marking pen
   Suction tubing
   Blades (2) No. 10 (3) No. 15
   Dissector (e.g. peanut)
   Bulb syringe (2)
   Umbilical tapes, vessel loops
   Nerve stimulator (locator)

   Suction drainage unit (e.g. Hemovac).

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