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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shoulder due to mechanical stimulation <strong>of</strong>the nerve (Figure 23).a scalpel (Figure 24). This exposes structuresdeep to the SCM i.e. the remainder <strong>of</strong>Levels II and III <strong>of</strong> the neck and the lateralsurface <strong>of</strong> the omohyoid muscle as itcrosses the internal jugular vein. A number<strong>of</strong> small vessels entering the muscle areencountered and cauterized. The dissectionis carried posteriorly along the deep aspect<strong>of</strong> the muscle in a subepimysial plane up tothe posterior edge <strong>of</strong> the SCM.ArteryFigure 22: SCM branch <strong>of</strong> occipital arterytethering the XIInFigure 24: Dissect along the anteriorborder <strong>of</strong> the sternomastoid in asubepimysial plane taking care not toinjure the XIn where it enters the muscleFigure 23: Dividing the SCM branch <strong>of</strong> theoccipital artery frees the XIIn that thenleads directly to IJV. Note the XIn and thetunnel created behind IJVStep 4 (Figure 7)ECAXIInIJVTunnelXInDissect with a scalpel or electrocauteryalong the omohyoid and strip the fattytissue in the anterior parts <strong>of</strong> Levels II andIII from the underlying infrahyoid strapmuscles in a posterior direction towardsthe carotid sheath.Divide the epimysium along the anteriorborder <strong>of</strong> the SCM using electrocautery orStep 5 (Figure 7)Attention is now directed to clearing LevelIIb which is located posterior to the IJVand deep to SCM. Opinions differ as towhether Level IIb (posterior to XIn) needsto be routinely dissected so as to minimisetrauma to the XIn.The upper part <strong>of</strong> the SCM is retractedposteriorly to expose Level IIb. With ahaemostat, create a tunnel immediatelyposterior to the IJV down to theprevertebral muscles (Figure 23). Thismanoeuver speeds up the subsequentdissection <strong>of</strong> Level IIb by clearlydelineating the posterior wall <strong>of</strong> the IJV.The transverse process <strong>of</strong> the C1 vertebracan be palpated immediately posterior tothe XIn and IJV and serves as an additional8