📝 “What are Key Layers & Landmarks of the Neck Dissection?”

- 1.3.25Quick Review #260 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental In a modified selective neck dissection (MSND), the surgeon encounters several tissue layers and critical anatomical structures:1. Skin and Subcutaneous Tissue• The incision traverses skin and subcutaneous fat.Critical anatomy: The marginal mandibular branch of the facial nerve is superficial, running below the lower border of the mandible and crossing superficial to the facial artery and vein. It is susceptible to injury during flap elevation.2. Platysma Muscle• A thin, superficial muscle encountered immediately beneath the subcutaneous tissue.Critical anatomy: Care is taken to preserve the marginal mandibular nerve, which lies deep to the platysma but superficial to the deep cervical fascia.3. Deep Cervical Fascia• Divided into layers: the investing, pretracheal, and prevertebral fascia. In MSND, the investing layer is dissected to expose deeper structures.Critical anatomy:• The external jugular vein is encountered superficially as it pierces the fascia.• The spinal accessory nerve runs within the fascia, often within Level II, and must be preserved unless oncologically involved.4. Fat and Lymphatic Tissue (Level I-V Compartments)• Lymphatic tissue and nodes are removed based on the involved levels (e.g., Levels I-III in a selective dissection).Critical anatomy:• Level II contains the spinal accessory nerve.• The hypoglossal nerve is encountered at Level IIA, running near the lingual artery.• The lingual and facial arteries and their veins are ligated as needed.5. Vascular Structures• The internal jugular vein and carotid artery are exposed and preserved unless oncologically indicated.• Critical anatomy: The marginal mandibular nerve crosses superficial to the facial artery and vein, which are ligated during Level I dissection.6. Deep Neck Structures• The dissection concludes near the prevertebral fascia, which forms the innermost layer.Critical anatomy:• The vagus nerve lies between the carotid artery and internal jugular vein.• The phrenic nerve courses along the anterior scalene muscle and must be preserved.References:1. HeadMirror. (n.d.). 3D Head & Neck Section: Chapter 3 - Neck Dissection.2. Shah, J. P., & Patel, S. G. (2012). Head and neck surgery and oncology (4th ed.). Elsevier.3. Maran, A. G. D., & Stell, P. M. (2012). Stell & Maran’s textbook of head and neck surgery and oncology (5th ed.). Taylor & Francis.4. Miloro, M., Ghali, G. E., Larsen, P. E., & Waite, P. D. (Eds.). (2022). Peterson’s principles of oral and maxillofacial surgery (4th ed.). Springer5. ChatGPT. 2024#podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher