Radical neck dissection

Cervical lymph node metastasis often occurs in laryngeal and laryngeal cancers. Neck dissection should be considered when performing a laryngeal primary cancer surgery. Neck dissection has become an indispensable treatment for surgical treatment of laryngeal and laryngeal cancer. Treatment of diseases: laryngeal cancer Indication 1. The primary cancer of the head and neck has been diagnosed, and the cervical lymph nodes are positive. 2. The primary tumor is difficult to ascertain, the cervical lymph nodes are enlarged, and the pathologically confirmed positive. 3. The primary tumor has undergone radiotherapy control and cervical lymph node positive after surgical resection. 4. Late head and neck cancer, although neck lymph nodes are negative, but highly suspected neck metastasis. 5. Neck lymph node positive, confirmed by B-ultrasound and CT scan has violated the carotid artery, can be ligated to remove the carotid artery or transplanted with artificial blood vessels. Contraindications 1. The primary tumor has not been controlled or has been inoperable. 2. There have been distant metastatic cancers. 3. The range of neck metastasis is large, such as invading the skull base, mediastinum, anterior fascia, cervical vertebrae, subcutaneous extensive metastasis, etc., there is no possibility of complete resection. 4. Patients with poor general condition, including heart, lung, liver, kidney and other dysfunction, hypertension, diabetes, blood system diseases. Preoperative preparation 1. The whole body examination is the same as the general surgery. 2. Neck examination, including neck palpation, measuring the diameter of lymph nodes, B-ultrasound to determine the relationship between lymph nodes and large vessels in the neck, CT scan to observe the large blood vessels in the neck, pre-vertebral, skull base invasion or metastasis. 3. Check the primary tumor and make an estimate of its extent and extent. 4. Carotid angiography is performed as necessary to determine the extent to which the artery is invaded by the tumor. 5. The neck is prepared from the mastoid, cheek, and the upper chest. Surgical procedure Anesthesia and position General anesthesia is usually performed by an orotracheal intubation or tracheotomy. The position is in a supine position, the shoulder pads, the neck is fully reclined, the head is turned to the non-surgical side, and the surgical side is fully exposed. Surgical procedure 1. The incision is first selected to be fully exposed, it is easy to remove the tumor, the incision flap does not undergo necrosis, and the carotid artery is avoided, the scar after surgery is reduced, and the incision with cosmetic effect is obtained. Unilateral neck dissection usually uses an L-shaped incision, starting from the mastoid tip, along the posterior edge of the sternocleidomastoid, descending to the oblique midline of the annular cartilage plane, or using a double-forked incision, or applying a T-shaped incision from the milk The protruding point reaches the midline along the plane of the hyoid bone below the mandibular margin. The other incision is perpendicular to the incision and descends along the sternocleidomastoid muscle to the midline of the clavicle. If a laryngectomy is performed at the same time as a double neck dissection, a U-shaped incision is made from the mastoid tip, which merges down the sternocleidomastoid muscle to the annular cartilage plane. For adequate exposure, the bilateral incision is added to the outside of the U-shaped mouth to extend outward to the midpoint of the clavicle. In short, there are many types of incisions, and which kind of incision is chosen depends on the needs of the operation. 2. Separate the flap to separate the flap from the deep platysma, and lift the platysma together with the skin. The upper part is separated to the lower edge of the mandible, the lower part is the clavicle, the front is to the midline of the neck, and the posterior to the trapezius muscle. The flap was sutured around with a No. 1 silk thread. 3. Neck cleaning starts from the back triangle of the neck, first dissecting the shoulder lock triangle. The deep cervical fascia was cut from the upper third of the clavicle, and the sternum and clavicle of the sternocleidomastoid muscle were cut at 2 cm on the collarbone. The muscle ends were ligated with thick silk thread and the sternocleidomastoid muscle was upward. Pulling, peeling off the fat tissue on the clavicle, the lower end of the external jugular vein can be seen and ligated and cut. At the junction of the anterior oblique angle of the trapezius muscle and the clavicle, the inferior abdomen of the scapula is cut off. The transverse carotid artery and vein are separated and the branches are ligated and cut, and the scalene muscle and the anterior scalene muscle are visible. The surface of the phrenic nerve passes through, and the brachial plexus is separated from the lateral side of the scalene muscle. The accessory nerve is separated upward on the leading edge of the trapezius muscle, which can be cut off, and the accessory nerve lymph node group in the occipital triangle region is removed. 4. After closing the large specimen of the wound neck, the surgeon replaces the surgical gown and gloves, replaces the surgical instruments, and prepares the suture. First flush the wound with saline, check for bleeding, fully stop bleeding, put into the drainage tube, connect negative pressure drainage, suture the skin under the skin, and place the sterile dressing under pressure.