Level III Selective Neck Dissection Sample Report
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in supine position on the operating room table. General anesthesia was then induced and the patient was intubated without complication. The patient was prepped and draped and pressure points were checked for right selective neck dissection.
A hockey-stick incision was fashioned over the right side of the neck, after 6 mL of 2% lidocaine with 1:100,000 epinephrine was injected into an area overlying the natural skin crease. Subplatysmal flaps were elevated after the skin incision was made in a superior and inferior direction.
Dissection was first performed along the anterior aspect of the sternocleidomastoid muscles. The fascia over this was grasped and, using Bovie electrocautery, this was dissected off the anterior and medial portion of the muscle reflecting the fascia and fat anteriorly. More superiorly, the spinal accessory nerve was identified and was seen to be superior to the area of dissection and this nerve was preserved.
Dissection was carried further, inferiorly, until the cervical roots were identified. The dissection was carried over the cervical root, taking the fat, fascia, and lymph nodes in the level III, and reflecting them anteriorly. This was done anteriorly until the carotid artery was identified and preserved. At this point, attention was then turned to the superior aspect of the planned excision.
Dissection was taken along the right submandibular gland, which was noted to be ptotic. The marginal mandibular nerve was identified and preserved. Dissection was carried more inferiorly until the digastric muscles were identified. This was reflected superiorly and the lingual nerve was identified and it was seen to be out of harm’s way and left superiorly, and the fat and fascia was dissected and reflected inferiorly to go with the specimen.
The hypoglossal nerve was traced posteriorly until the jugular vein was identified and this was preserved. Attention was then paid inferiorly.
Dissection over the omohyoid muscle with reflection of fat, fascia, and lymph nodes superiorly revealed deep to the omohyoid muscle the inferior aspect of the jugular vein; this was identified and preserved. Attention was again paid to the deep aspect of the neck over the scalene muscles. The fat and fascia in this area along with the lymph nodes was reflected anteriorly with the specimen. This was dissected off the carotid artery and then the jugular vein, preserving all branches. The face nerve was also identified and preserved.
Further dissection anteriorly freed the specimen entirely and that was then sent to for examination to rule out lymphoma. The patient’s neck was then copiously irrigated with sterile salines. Small bleeding points were controlled using bipolar electrocautery.
A #15 drain was placed through stab incision in the right aspect of the neck and hooked up to bulb suction. The platysmal layer was reapproximated using 4-0 Vicryl in a simple interrupted fashion and the skin was reapproximated using a single running Prolene 4-0.
Steri-Strips were placed. Tegaderm and Telfa were placed over the patient’s wound and the patient was then awoken, extubated, and taken to postanesthesia care unit.
