By Vijay P. Khatri MD FACS
Improve your surgical services with Atlas of complex Operative surgical procedure! This new source selections up the place different surgical references depart off, supplying hugely visible, step by step assistance on greater than a hundred complex and complicated approaches in either common and subspecialty parts.
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Extra resources for Atlas of Advanced Operative Surgery
Lingual nerve External jugular vein SCM Submandibular duct (cut) Facial artery Submandibular gland External jugular vein (cut) Spinal accessory nerve Great auricular nerve Figure 2-3. SCM, Sternocleidomastoid. SCM Trapezius muscle External jugular vein 14 Section I • Head and Neck Once the accessory nerve is identified, it is dissected in its entire length from insertion into the trapezius to the posterior portion of the sternomastoid muscle. The portion of the sternomastoid is cut in this region anterior to the accessory nerve.
However, imaging will indicate the location of the tumor and whether the margins are irregular. Imaging is helpful for the patient presenting with an aggressive parotid tumor, such as facial nerve palsy or a long-standing deep-lobe parotid tumor. Tumors in the tail of the parotid are usually Warthin tumors, and a preoperative fine-needle aspiration biopsy (FNA) is quite helpful. Even though there continues to be considerable controversy about the role of FNA, in select circumstances it is quite helpful.
A clamp is placed on the deeper portion of the submandibular salivary gland along with the Wharton duct. The specimen is retracted posteriorly. u The dissection continues on the hyoglossus muscle. The facial artery is clamped and ligated medial to the posterior belly of the digastric muscle. u Now the dissection continues posteriorly behind the jugular vein in the posterior triangle. The cervical plexus is identified. The lymphoid structures are pulled anteriorly, and the dissection continues on the surface of the internal jugular vein.
Atlas of Advanced Operative Surgery by Vijay P. Khatri MD FACS