Bilateral Modified Radical Neck Dissection
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Procedure Outline
Table of Contents
- Patient positioning
- Surgical approach and marking
- Create extended Kocher incision
- Develop subplatysmal flaps
- Identify GAN and follow to Erb’s point
- Identify SAN and follow to insertion to trapezius muscle
- Mobilize level V compartment from lateral to medial
- Divide EJV
- Unwrap fascia around the SCM
- Circumferentially dissect and preserve carotid sheath contents
- Further mobilize lymph node specimen from lateral to medial, including levels V, IV, III and II
- Identify and preserve (or ligate) thoracic duct (left side) or other minor lymphatic ducts (right)
- Identify and preserve phrenic and brachial plexus nerves
- Divide transverse cervical nerve branches as necessary for complete mobilization of lymph node specimen
- Place a drain deep to the SCM for decompression of residual lymphatic fluid
- Close strap muscles
- Close platysma muscles
- Close dermis with 5-0 Prolene
- Apply Dermabond and Steri-Strips
- Remove drain once output is less than 30-50 cc and serosanguinous (usually postoperative day 2)