8-A837A-2017-Books-00129-029-060_Katz_Sec1_Ch02-ROUND-1

S E C T I O N I | T H Y R O I D

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Hypoglossal nerve Carotid bifurcation Facial vein (ligated) Internal jugular vein Cervical plexus

Spinal accessory nerve Digastric muscle

Anterior and inferior nodes Hypoglossal nerve

Internal jugular vein Carotid bifurcation

Cervical plexus

FIGURE 2-11  Spinal accessory nerve and cervical plexus dissection to level II.

the digastric muscle, the spinal accessory nerve will be encountered as it heads under the SCM toward the posterior triangle. The dissection is completed superiorly when the surgeon encounters the posterior belly of the digastric muscle. The nodal content of level V may be exposed by either retracting the SCM later- ally or medially (Fig. 2-12). Retraction of the SCM laterally is often facilitated by

Proximal spinal accessory nerve Internal jugular vein

Carotid bifurcation Hypoglossal nerve Digastric muscle

SCM

Anterior and inferior nodes

Distal spinal accessory nerve

Omohyoid (separated)

Transverse cervical artery Brachial plexus

FIGURE 2-12  From under the sternocleidomastoid muscle (SCM), the specimen and the fat tissues of the neck and lymphatics are re- sected as one as all are removed from the great vessels and passed from under the SCM. As the mandible is pulled in a superior direc- tion with a retractor and the proximal spinal accessory and hypo- glossal nerves are preserved, the surgeon pulls the entire specimen from its inferior-medial position.