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Bilateral Modified Radical Neck Dissection

Tobias Carling, MD, PhD, FACS
Yale School of Medicine

1. Introduction

2. Surgical Approach

  1. Position Patient
  2. Mark for Incisions

3. Formation of Subplatysmal Flaps

  1. Incision and Collection of Scar Revision Specimen
  2. Dissect through Platysma
  3. Identify Greater Auricular Nerve
  4. Finalize Subplatysmal Flaps

4. Dissection to Internal Jugular Vein (IJV)

  1. Identify Accessory Nerve
  2. Ligate External Jugular Vein
  3. Mobilize and Isolate Sternocleidomastoid (SCM)
  4. Mobilize Omohyoid Muscle
  5. Evaluate Tumor Spread
  6. Resect Omohyoid Muscle

5. Isolation and Mobilization of IJV

  1. Place Vessel Loop around IJV
  2. Identify Digastric Muscle and Hypoglossal Nerve
  3. Dissect Following Carotid
  4. Identify Vagus Nerve
  5. Follow IJV inferiorly

6. Resection of Tumor

  1. Lateral to Medial Tumor Mobilization
  2. Ligate Internal Jugular Vein
  3. Separate Vagus Nerve and Collect Marginal Specimen
  4. Resect Bulk of Tumor
  5. Resect Residual Tumor

7. Left Side Summary and Inspection

8. Right Side - Subplatysmal Flaps

9. Dissection to IJV

  1. Dissect out External Jugular
  2. Isolate and Mobilize SCM
  3. Isolate and Inspect Omohyoid Muscle

10. Isolation of IJV and Vagus Nerve

11. Resection of Tumor

  1. Resect Level II Specimen
  2. Follow IJV
  3. Lateral to Medial Mobilization of Tumor
  4. Resect Bulk of Tumor

12. Right Side Summary and Inspection

13. Placement of Drains

14. Closure

15. Post-op Remarks