(15) A laryngectomy tube is inserted into the tracheal stoma; a pressure
dressing is applied to the wound and neck.
1-45. RADICAL NECK DISSECTION
a. General. This operation involves the removal of a tumor, surrounding
structures, and lymph nodes en massa, through a Y-shaped or trifurcate incision in the
affected side of the neck. It is done to remove the tumor and metastatic cervical nodes
present in malignant lesions and all nonvital structures of the neck. Metastasis occurs
through the lymphatic channels via the bloodstream. Disease of the oral cavity, lips,
and thyroid gland may spread slowly to the neck. Radical neck surgery is done in the
presence of cervical node metastasis from a cancer of the head and neck, which has a
reasonable chance of being controlled. It may also be done in a slightly less radical
form when there is cancer of the tongue and no firm evidence of metastasis.
b. Preparation of the Patient.
(1) The patient is placed on the table in a dorsal recumbent position, with
the head in moderate extension and the entire affected side of the face and neck facing
uppermost. During surgery, the face of the patient is turned away from the surgeon.
(2) The preoperative skin preparation is extensive. The patient is draped
with sterile towels and sheets, leaving a wide operative field. Endotracheal anesthesia
is used. The anesthetic is administered before the patient is positioned for surgery.
During the operation, the anesthesiologist works behind the sterile barrier, away from
the surgical team.
c. Operative Procedure.
(1) One of several types of incisions may be used, including the Y-shaped,
H-shaped, or trifurcate incision.
(2) The upper curved incision is made through the skin and platysma, using
a knife, tissue forceps, and fine hemostats and ligatures for bleeding vessels. The
upper flap is retracted; then the vertical portion of the incision is made and the skin flaps
retracted anteriorly and posteriorly with retractors. The anterior margin of the trapezius
muscle is exposed by means of curved scissors. The flaps are retracted to expose the
entire lateral aspect of the neck. Branches of the jugular veins are clamped, ligated,
(3) The sternal and clavicular attachments of the sternocleidomastoid
muscle are clamped with curved Rochester-Mayo clamps and then divided with a knife.
The superficial layer of deep fascia is then incised. The omohyoid muscle is severed
between clamps just above its scapular attachment.