Special Surgical Procedures II LESSON 1: Eye, Ear, Nose, and Throat (EENT) Surgery Section IV: THROAT, TONGUE, AND NECK SURGERY
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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.
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