Selective Neck Dissection - Vula - University of Cape Town

CervicalplexusStep 7 (Figure 7)Continue stripping the fat and lymphaticsaround the anterior aspect of IJV until thecommon carotid artery is again reached.Divide and ligate tributaries of the IJVwith silk ties (Figure 31).Figure 28: Anterograde dissection ofLevels II and III, preserving the cervicalplexusIJVCarotidXnAnsaXInFigure 29: IJV, common carotid artery,Xn, IJV, ansa cervicalis and XInThe carotid sheath is incised along the fullcourse of the vagus nerve, and the neckdissection specimen is stripped off the IJVwhile dissecting inside the carotid sheath.The ansa cervicalis, which courses eitherdeep or superficial to the IJV may bepreserved (Figures 29, 30).Figure 31: Divide and ligate tributaries ofthe IJVInferiorly the fatty tissue at the junction ofLevels III and IV is divided at the level ofthe omohyoid (supraomohyoid neckdissection). Identify and preserve thesuperior thyroid artery where it originatesfrom the external carotid artery (Figure32).DescendenshypoglossiFigure 32: Identify and preserve thesuperior thyroid arteryFigure 30: Further anterior dissectionshowing descendens hypoglossi componentof ansa cervicalisWith a Lateral ND Level IV is resected byapplying traction to the fatty tissue deep tothe omohyoid in a cephalad direction whiledissecting it from Level IV with a scalpel;the transverse cervical vessels may be10