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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Step 2 (Figure 7)54663Figure 7: Recommended surgical steps forsupraomohyoid neck dissectionanterior jugular veins. The contents <strong>of</strong> thesubmental triangle are resected withelectrocautery up to the hyoid bone. Thedeep plane <strong>of</strong> dissection is the mylohyoidmuscle (Figures 8, 9).27 41The surgeon next addresses Level Ib <strong>of</strong> theneck. The fascia (capsule) overlying thesubmandibular gland is incised midwayover the gland and is dissected from thegland in a superior direction in a subcapsularplane so as to avoid injury to the marginalmandibular nerve (Figure 10). Usingthis technique the marginal mandibularnerve does not need to be routinelyidentified; the assistant however watchesfor twitching <strong>of</strong> the lower lip as this indicatesproximity to the nerve. The marginalmandibular nerve crosses the facialartery and vein (Figure 11).The facial arteryand vein are identified by blunt dissectionwith a fine haemostat (Figure 11).Figure 8: Resection <strong>of</strong> submental triangleFigure 10: Incision <strong>of</strong> submandibularsalivary gland capsuleFigure 9: Resection <strong>of</strong> submental trianglefrom mylohyoid muscleNext attention is directed to the fat andlymph nodes tucked anteriorly betweenthe anterior belly <strong>of</strong> digastric and mylohyoidmuscle (Figure 11). These nodes areespecially important to resect withmalignancies <strong>of</strong> the anterior floor <strong>of</strong>mouth. To resect these nodes one retractsthe anterior belly <strong>of</strong> digastric anteriorlyand delivers the tissue using electrocauterydissection with the deep dissection planebeing on the mylohoid muscle (Figures 12,13).4