Dissection Of The Central Compartment

The prelaryngeal, pretracheal, and paratracheal lymph nodes constitute the central lymphatic compartment of the neck (area VI). Lymph nodes in this area are mainly located in the

Figure 4-52 Midline incision for the dissection of the fascia over the strap muscles.

Figure 4-54 The right superior thyroid artery crosses inferomedially toward the thyroid gland. CA, carotid artery; st, superior thyroid artery; oh, omohyoid muscle; sh, sternohyoid muscle.

tracheoesophageal groove and around the recurrent laryngeal nerve. The lateral boundaries of this region are the common carotid arteries, the superior boundary is the hyoid bone, and the inferior boundary is the suprasternal notch (Fig. 4-55).

For some tumor locations the central compartment must be included in the dissection. This is the case of tumors of the thyroid gland, subglottic lesions, and some hypopharyngeal cancers. In some cases, it is also important to remove the lymph nodes in the anterior superior mediastinum along with the dissection of the central compartment.

Figure 4-55 Anatomical boundaries of the central compartment of the neck. CA, carotid artery; IJ, internal jugular vein; hb, hyoid bone; sn, suprasternal notch; tg, thyroid gland.

During the dissection of the central compartment, the recurrent laryngeal nerve must be identified and preserved in a patient with normal vocal cord function whose primary tumor does not require the removal of the ipsilateral larynx. Identification of the nerve should be attempted before further removal of lymphatic tissue from the central compartment in order to assure its preservation (Fig. 4-56A). The nerve is then followed upward toward the larynx and downward to the upper mediastinum. The inferior thyroid artery is ligated and divided when total

Figure 4-56 Identification of the recurrent laryngeal nerve and parathyroid glands (right side). (A) The recurrent laryngeal nerve and both parathyroid glands are identified before dissection of the central compartment. (B) The inferior thyroid artery is ligated and divided, and the nerve is completely exposed. TG, thyroid gland; rl, recurrent laryngeal nerve; sp, superior parathyroid gland; ip, inferior parathyroid gland; it, inferior thyroid artery.

Figure 4-56 Identification of the recurrent laryngeal nerve and parathyroid glands (right side). (A) The recurrent laryngeal nerve and both parathyroid glands are identified before dissection of the central compartment. (B) The inferior thyroid artery is ligated and divided, and the nerve is completely exposed. TG, thyroid gland; rl, recurrent laryngeal nerve; sp, superior parathyroid gland; ip, inferior parathyroid gland; it, inferior thyroid artery.

Figure 4-57 Vascular pattern of a parathyroid gland (microphotograph x25). pt, parathyroid gland; it, inferior thyroid artery ligated.

Figure 4-58 The neck after a right functional neck dissection for supraglottic cancer of the larynx. IJ, internal jugular vein; CA, carotid artery; SG, submandibular gland; oh, omohyoid muscle; sh, sternohyoid muscle; ls, levator scapulae muscle; as, anterior scalene muscle; SC, sternocleidomastoid muscle.

Figure 4-58 The neck after a right functional neck dissection for supraglottic cancer of the larynx. IJ, internal jugular vein; CA, carotid artery; SG, submandibular gland; oh, omohyoid muscle; sh, sternohyoid muscle; ls, levator scapulae muscle; as, anterior scalene muscle; SC, sternocleidomastoid muscle.

lobectomy is planned (Fig. 4-56B), and the lymphatic tissue is removed from the central compartment of the neck.

Adequate management of the parathyroids is also extremely important in all cases. At least one gland should be identified on each side and their blood supply must be preserved (Fig. 4-57). When this is not possible because of the vascular anatomy of the parathyroids or as a consequence

tv

PG

SG

»P

hn

dm

sa

fix Wv *

I

si

«ft sh

SC

BP P» te as

CA

TO

3. (VJ^

Figure. 4-59 Artist's view of the neck after right functional neck dissection. IJ, internal jugular vein; fv, distal stump of the facial vein; CA, carotid artery; st, superior thyroid artery; SG, submandibular gland; PG, parotid gland; TG, thyroid gland; oh, omohyoid muscle; sh, sternohyoid muscle; dm, digastric muscle; sp, splenius capitis muscle; ls, levator scapulae muscle; as, anterior scalene muscle; SC, sternocleidomastoid muscle; sa, spinal accessory nerve; vn, vagus nerve; pn, phrenic nerve; hn, hypoglossal nerve; BP, brachial plexus; tc, transverse cervical artery; deep branches of the cervical plexus.

of the extension of the nodal disease, every attempt should be made to autotransplant enough parathyroid gland tissue to a muscle in the neck. In patients with thyroid cancer this is generally performed in the sternocleidomastoid muscle. In all patients undergoing central compartment dissection careful postoperative calcium monitoring is mandatory.

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook


Post a comment