Selective Neck Dissection - Vula - University of Cape Town
Selective Neck Dissection - Vula - University of Cape Town
Selective Neck Dissection - Vula - University of Cape Town
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CervicalplexusStep 7 (Figure 7)Continue stripping the fat and lymphaticsaround the anterior aspect <strong>of</strong> IJV until thecommon carotid artery is again reached.Divide and ligate tributaries <strong>of</strong> the IJVwith silk ties (Figure 31).Figure 28: Anterograde dissection <strong>of</strong>Levels II and III, preserving the cervicalplexusIJVCarotidXnAnsaXInFigure 29: IJV, common carotid artery,Xn, IJV, ansa cervicalis and XInThe carotid sheath is incised along the fullcourse <strong>of</strong> the vagus nerve, and the neckdissection specimen is stripped <strong>of</strong>f 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 <strong>of</strong>the IJVInferiorly the fatty tissue at the junction <strong>of</strong>Levels III and IV is divided at the level <strong>of</strong>the 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 component<strong>of</strong> 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