Selective Neck Dissection - Vula - University of Cape Town
Selective Neck Dissection - Vula - University of Cape Town
Selective Neck Dissection - Vula - University of Cape Town
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
The submandibular ganglion, suspendedfrom the lingual nerve, is clamped, dividedand ligated, taking care not to cross-clampthe lingual nerve (Figure 16).Figure 14: Finger dissection delivers thesubmandibular gland and duct, and bringsthe lingual nerve into view. The proximalstump <strong>of</strong> the facial artery is visible at thetip <strong>of</strong> the thumb, and the XIIn is seenbehind the nail <strong>of</strong> the index fingerThe facial artery is divided and ligatedjust above the posterior belly <strong>of</strong> digastric(Figure 17). Note: A surgical variation <strong>of</strong>the above technique is to preserve thefacial artery by dividing and ligating the 1-5 small branches that enter the submandibulargland. This is usually simple to do,it reduces the risk <strong>of</strong> injury to the marginalmandibular nerve, and permits the use <strong>of</strong> abuccinator flap based on the facial artery(Figure 18).Figure 15: Submandibular ductFigure 17: Clamping and dividing thefacial artery just above the posterior belly<strong>of</strong> digastricFigure 16: Separating the submandibularganglion from the lingual nerveFigure 18: Facial artery has been keptintact; a branch is being divided6