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  • Title
  • 1. Introduction
  • 2. Surgical Approach and Preparation
  • 3. Incision and Division of the Platysma
  • 4. Subplatysmal Flaps
  • 5. Access to the Lateral Neck Between the Medial Edge of Sternocleidomastoid (SCM) and the Lateral Edge of Sternohyoid
  • 6. Omohyoid Dissection and Division
  • 7. Internal Jugular Vein Dissection and Preservation
  • 8. Superior Extent of Dissection in Levels IIB and III
  • 9. Lateral Extent of Dissection Under SCM
  • 10. Deep Extent of Dissection to Deep Cervical Fascia
  • 11. Dissection into Level IV Watching for Positive Metastatic Lymph Node and Thoracic Duct
  • 12. Inferior Extent of Dissection in Level IV at Clavicle with Preservation of Thoracic Duct
  • 13. Lateral Dissection at Junction Between Levels IV and V
  • 14. Last Remaining Attachments at Deep and Lateral Margins to Remove Specimen
  • 15. Specimen Orientation
  • 16. Review of Anatomy
  • 17. Irrigation, Hemostasis with Tisseel and Surgicel, and Final Check of Vagus and Phrenic Nerves
  • 18. Closure
  • 19. Post-op Remarks

Left Lateral Neck Dissection for Metastatic Papillary Thyroid Carcinoma

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Sarah A. Brownlee, MD; Allison S. Letica-Kriegel, MD, MSc; Antonia E. Stephen, MD
Massachusetts General Hospital

General SurgeryOtolaryngology

Procedure Outline

Table of Contents

  1. 1. Introduction
    1. 2. Surgical Approach and Preparation
      1. 3. Incision and Division of the Platysma
        1. 4. Subplatysmal Flaps
          1. 5. Access to the Lateral Neck Between the Medial Edge of Sternocleidomastoid (SCM) and the Lateral Edge of Sternohyoid
            1. 6. Omohyoid Dissection and Division
              1. 7. Internal Jugular Vein Dissection and Preservation
                1. 8. Superior Extent of Dissection in Levels IIB and III
                  1. 9. Lateral Extent of Dissection Under SCM
                    1. 10. Deep Extent of Dissection to Deep Cervical Fascia
                      1. 11. Dissection into Level IV Watching for Positive Metastatic Lymph Node and Thoracic Duct
                        1. 12. Inferior Extent of Dissection in Level IV at Clavicle with Preservation of Thoracic Duct
                          1. 13. Lateral Dissection at Junction Between Levels IV and V
                            1. 14. Last Remaining Attachments at Deep and Lateral Margins to Remove Specimen
                              1. 15. Specimen Orientation
                                1. 16. Review of Anatomy
                                  1. 17. Irrigation, Hemostasis with Tisseel and Surgicel, and Final Check of Vagus and Phrenic Nerves
                                    1. 18. Closure
                                      1. 19. Post-op Remarks
                                        1. Approximate SCM to Sternohyoid
                                        2. Release Neck Extension and Close Platysma
                                        3. Deep Dermal Sutures
                                        4. Skin with Running, Knotless Monocryl Subcuticular Suture and Steri-Strips

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                                        Authors

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                                        Massachusetts General Hospital

                                        Article Information

                                        Publication Date
                                        Article ID466
                                        Production ID0466
                                        Volume2026
                                        Issue466
                                        DOI
                                        https://doi.org/10.24296/jomi/466