Modified Radical Neck Dissection for Cervical Metastasis

This study aims to address the lack of detailed instructional videos and standardized guidance for performing modified radical neck lymph node dissection surgery. The surgical procedures demonstrated here have clear boundaries, thorough structural and anatomical dissection, and are easy to learn. Make a transverse incision from the chin midline to two centimeters below the mandibular margin.

Then extend a longitudinal incision along the trapezius muscles, anterior edge to the middle or lower one third junction. Curve downward and forward over the clavicle midpoint, ending three centimeters below the clavicle. In size, the platysma muscle with a scalpel or tissue scissors.

Elevate the rectangular flap sharply from the platysma deep surface. Then extend the submental incision one centimeter above the mandibular margin. Now, separate the sternomastoid muscles clavicular insertion using curved hemostats.

Transect the clavicular and sternal heads, one to 1.5 centimeters above the clavicle. Ligate cut ends and elevate the muscle. In size, the carotid sheath and identify the internal jugular vein, common carotid artery and vagus nerve.

Next, make a longitudinal incision along the carotid sheaths medial side. Ligate all branches draining into the vein. Mobilize the sheaths superficially and laterally to ensure on block lymphoid removal.

Identify the accessory nerve at the trapezius muscles mid-lower one-third junction, dissect proximally along the nerve, preserving it if uninvolved by tumor. Now identify the phrenic nerve beneath the prevertebral fascia. Ligate the external jugular vein, suprascapular vessels, and transverse cervical vessels one centimeter above the clavicle.

Transect the supraclavicular adipose tissue and omohyoid muscle. Then in size, the deep cervical fascia along the sternal hyoid muscle. Retract the sternocleidomastoid muscle.

Transect the omohyoid at its hyoid attachment. Dissect the trapezius anterior margin upward to the mastoid. Ligate the adipose tissue and vascular branches while preserving the accessory nerve.

Lift the tissue block and dissect along the prevertebral fascia toward the mastoid. Ligate cervical plexus branches, but avoid injuring the brachial plexus and phrenic nerve. Transect the sternocleidomastoid muscle at the mastoid tip with electrocautery.

Transect the sternocleidomastoid muscle at the mastoid tip with electrocautery. Then resect the parotids lower pole and ligate the posterior facial vein and external jugular vein. Preserve the marginal mandibular nerve if feasible.

For submandibular dissection. Incise the deep fascia along the mandible. Preserve the marginal mandibular nerve.

Then ligate the facial artery and vein. Dissect the submandibular gland and nodes. Identify the hypoglossal and lingual nerves and ligate the submandibular duct near its orifice to spare the lingual nerve.

To close the wound. First, irrigate the cavity with normal saline. Apply diluted povidone-iodine solution.

Place a double tube negative pressure drain in the wound's lowest point. Secure the 60 milliliter drain with a 3.0 purse-string suture. Then suture the platysma, subcutaneous and skin in sequence and apply a light dressing.

The entire cervical tissue specimen was successfully excised. Key anatomical structures were exposed and preserved after meticulous dissection and hemostasis. 30 lymph nodes were isolated from the cervical tissue and are organized by level for pathological examination.

Pre and postoperative comparison photographs showed that the patient demonstrated good recovery without visible complications. Among 30 patients, the postoperative complication rate was under 5%with a hospital stay of six to seven days and no 30-day morbidity or mortality.