Dissection of levels II and III
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This segment describes the dissection of levels Ia and Ib.
- Head and neck cancer
- Supraomohyoid neck dissection
- Nodal metastasis
- Oral squamous cell cancer
- Cervical lymph nodes
- Level Ia
- Level Ib
About this video
- Krishnakumar Thankappan
- First online
- 02 March 2019
- Online ISBN
- Springer, Cham
- Copyright information
- © The Author(s) 2019
The procedure started with marking the transverse neck-crease incision. The skin is being incised. You can see the subcutaneous fat layer.
The platysma is being exposed and incised with the monopolar bovie cautery. A superior subplatysmal flap is being elevated.
It’s very important to stay close to the platysma to avoid an injury to the marginal mandibular nerve. Attention is now to level IA. The fibrofatty tissue between the two anterior belly of digastric is being removed. The lower limit is the hyoid bone.
The contents between the two digastric and anterior belly is the level IA. Attention is now on to level IB, the submandibular area. A subfascial dissection of the investing layer of deep cervical fascia is done. And the fascia is elevated to preserve the marginal mandibular branch of the facial nerve. The nerve is being demonstrated.
A careful removal of the perifascial nodes along the facial vessels is being done now. It is very important to clear these particular nodes.
The facial vein is being exposed now. The facial vessels are preserved. These vessels may be used as recipient vessels for the reconstruction of the surgical defect in the oral cavity.
The submandibular gland is being dissected of the facial artery the level IB, fibrofatty tissue, is seen here being gently dissected off from the inferior border of the mandible, as well as its anterior relation of the anterior belly of digastric muscle.
The delineation of the posterior border of the mylohyoid is being done now. The facial artery is further dissected off. And the submandibular gland is separated off.
The lingual now is now neutralized. The submandibular duct is seen ligated and cut. This finishes the level IB dissection.
And anatomical structures are being demonstrated. The posterior of digastric, the marginal mandibular nerve, the facial vein, the facial artery, and in the posterior border of the mylohyoid, the lingual nerve, and the hypoglossal nerve.