suprahyoid neck dissection

Surgical treatment of oral and maxillofacial malignant tumors. Malignant tumors originating in the head and neck and oral and maxillofacial regions, the metastasis pathways mostly through the lymphatic system, first manifested as the metastasis of the cervical lymph nodes. These cervical lymph node metastases are not sensitive to radiation and chemical drugs, and the treatment effect is often Not ideal enough. Cervical lymphadenectomy is an indispensable and effective method for curing malignant tumors of the head and neck and oral and maxillofacial regions. Clinically, the scope of lymphadenectomy is often determined according to the specific analysis and research of the patient's systemic and local conditions and the presence or absence of metastases. The name is based on the scope of lymphatic dissection, limited to the submandibular area, the upper part of the hyoid bone is called the upper lingual lymphadenectomy; the surgery is limited to the scapular scapula above the scope of the upper scapular lymphatic dissection; All neck lymph nodes are called full neck dissection. Total neck dissection is limited to one side, which is called a one-sided neck dissection; while bilateral surgery is called bilateral neck dissection (regardless of one operation or staged surgery). If the neck dissection and surgical resection of the primary tumor are surgical resection, it is called combined radical surgery. In addition, clinically, cancerous tumors with high degree of malignancy, poor differentiation, and rapid development of the disease, even if no lymph nodes with enlarged metastasis are found, cervical lymphadenectomy is performed. This type of surgery is called selective lymphadenectomy. Conversely, lymphatic dissection after clinically confirmed or highly suspected cervical lymph node metastasis is called therapeutic neck dissection. Treatment of diseases: lip cancer, gum cancer Indication The principle of selection of surgical indications for upper lymphatic dissection is based on the characteristics and zoning of cervical lymphatic drainage. 1. Lower lip squamous cell carcinoma. 2. Lower anterior teeth gum cancer. 3. Axillary malignant tumors. All three malignant tumors should be within the first phase of clinical stage, that is, in the state of TisN0M0, T1N0M0, T1N1M0. 4. Submandibular gland mixed tumor, this tumor is a critical tumor to avoid recurrence should be enlarged resection. 5. Cases of oral and maxillofacial carcinoma that cannot tolerate neck dissection. The choice of the above surgical indications should also be limited to the low degree of malignancy of the primary cancer and the early cases, the local lesions are not large, and the surgery can be completely removed. This procedure can be used clinically in cases where there is a possibility of metastasis of the upper neck and the patient's general condition does not allow for a wider range of dissection. For patients with a cancerous site that is above the midline and suspected or confirmed with contralateral lymphatic metastasis, bilateral supracondylar lymphadenectomy should be performed. Contraindications 1. Cases in which the primary tumor of the cancer cannot be completely removed by surgery or cannot be controlled by other treatment methods are not suitable for the operation of such limitation. Instead, a combination of comprehensive treatment and extended radical treatment should be adopted. 2. Lymphatic metastasis has exceeded the upper lingual area and should be considered for full neck dissection. 3. The general condition is poor and cannot tolerate this operator. Preoperative preparation 1. Regular body examination. 2. Make necessary allergy tests. 3. Regular preparation of skin. Surgical procedure Incision Take the arc incision under the jaw, 1.5 to 2 cm from the lower edge of the mandible. Starting from the middle of the iliac crest, stop at the mandibular angle and the anterior border of the sternocleidomastoid, about 6-8 cm long. Cut the skin, subcutaneous tissue and platysma. The shallow blunt surface of the deep platysma, the superficial deep fascia of the neck, is detached upwards until the lower edge of the mandible. 2. Ligation, cutting of the external and external veins of the jaw At the forefront of the chewing muscles, the lower edge of the mandible, and the free external and external veins, the ligation, and the cutting. The superficial surface of the mandibular branch of the facial nerve is traversed, and should be released after being released and protected. The shallow deep fascia of the neck was cut along the 2cm plane below the lower edge of the mandible, and the tissues around the submandibular area and the infraorbital area were dissected. The posterior abdomen of the second abdominal muscle, the anterior abdominal abdomen of the healthy side, and the body of the hyoid bone were exposed. At the bottom of the surgical field, the mandibular lingual muscles and the hyoid bones, and the entire upper lingual region (including the submandibular area and the underarm area) have all been free. From the top to the bottom and from the back to the front, the submandibular gland and the submandibular lymph node tissue were dissected from the inside of the mandible and pulled forward to expose the proximal end of the external maxillary artery, which was cut after double ligation. The mandibular ligament of the styloid process was severed, and the parotid lobes were separated from the posterior submandibular gland. After being cut off at the level of the mandibular angle, the suture was sutured on the posterior abdomen of the second abdominal muscle. In the process, the external jugular vein should be ligated and cut. At this point, you can see the hypoglossal nerve running on the surface of the hyoid bone. Above it, there is a lingual nerve that runs from the top to the bottom. The nerve should be properly protected from the submandibular gland. Cut off the tongue nerve to the secretory branch of the submandibular gland. After clearing the submandibular gland duct, it is ligated and cut as close as possible to the end of the catheter. Continue to dissect forward until the anterior abdomen of the contralateral abdominal muscles, and remove the submandibular gland, fat, lymph node tissue and honeycomb tissue in the upper part of the hyoid bone. 4. Wound treatment Rinse the wound and stop bleeding completely. The platysma, subcutaneous tissue and skin are layered. Set the half tube drainage. The wound is covered with a dressing and then pressure bandaged. complication 1. Intraoperative accidental injury of the facial nerve mandibular branch, lingual nerve and hypoglossal nerve should be promptly kissed, and given neurotrophic drugs after surgery. 2. The proximal ligament of the external maxillary artery is loose, which is generally not easy to occur. If it occurs during surgery, it should be immediately pressed to stop bleeding, find the broken end, and re-attach the ligation. If it occurs after surgery, the wound should be opened for re-disposal.