Neck incisions.pptx

Neck incisions

1. NECK INCISIONS DR G SRAVAN KUMAR

2. Lines of langer Lines of skin tension Topological lines drawn on a map of human body. Parallel to natural orientation of collagen fibres in the dermis Perpendicular to underlying muscle fibres.

3. The choice for a specific incision is based on a variety of factors, including personal preference previous radiotherapy or surgery, the site of the primary tumour and its resection.

4. The following are the main goals that should be achieved by the skin incision over neck: assure adequate vascularization of the skin flaps adequate exposure of the surgical field consider the localization of the primary tumour adequate protection of the major vessels consider preoperative factors, such as previous radiotherapy consider as well as facilitate reconstructive surgery, if needed include previous surgical fields (scars, incisions for biopsies, etc.) produce acceptable cosmetic results.

5. Submandibular gland excision Transverse neck incision between 2 to 3 centimeters in length along the inferior aspect of the submandibular gland and approximately 1 to 2 centimeters inferior to the inferior border of the mandible is made.

6. Parapharyngeal abscess Two types of external approach Modified apron incision - Used for exposure of submandibular region and upper part of para-pharyngeal space (levels I, II and III). The incision begins at submental triangle curves downward two finger breadth from the lower border of mandible toward greater horn of thyroid cartilage and extends across sternocleido-mastoid. The incision can be suitably modified according to extent of abscess.

7. Hockey stick incision: Used for exposure entire PPS. Incision begins at mastoid tip and extends across posterior triangle, then curves sharply toward midline and continues along anterior border of sternocleidomastoid, ending just short of sternoclavicular joint. The incision can be suitably modified according to extent of abscess.

8. Thyroid incisions Kocher’s thyroid incision : Transverse “collar” incision, 2 finger breadths above the suprasternal notch from one sternocleidomastoid to another

9. Tracheostomy incision The skin incision is made 2 cm below the center of the cricoid cartilage to exposure the inferior border of thyroid isthmus

10. Neck dissection

11. Modified schobinger incision Modified Schobinger's incision is the most common incision used for neck dissection. It has the advantage of adequate exposure and the incision can be easily extended anteriorly as lip splitting incision in order to expose the primary oral cavity tumor

12. Roy S, Shetty V, Sherigar V, Hegde P, Prasad R. Evaluation of Four Incisions Used For Radical Neck Dissection- A Comparative Study. Asian Pac J Cancer Prev. 2019 Feb 26

13. Total laryngectomy incisions Gluck Sorensen incision Vertical incision T shaped incision Crime Y incision Trap door incision Double trap door incision Apron incision

14. Gluck Sorenson incision U shaped Stoma is incorporated into incision Vertical limb is medial to medial border of SCM Highest limit is the mastoid process on both sides.

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