Neck Dissection: Neurologic Complications
摘要
KQ 11.1 In level I neck dissection, the procedure should be performed superficially to the fascia of the submandibular gland, with precise identification of the facial nerve’s marginal branch to avoid injury. The lingual nerve is exposed by mobilizing the submandibular gland and dissecting the submandibular triangle. The submandibular ganglion must be carefully divided without damaging the hypoglossal nerve. KQ 11.2 During level II dissection, the hypoglossal nerve is exposed when the posterior belly of the digastric muscle and the stylohyoid muscle are elevated superiorly. Identifying the spinal accessory nerve (SAN) involves locating the internal jugular vein (IJV), digastric muscle, and sternocleidomastoid (SCM) muscle, as it innervates both the SCM and trapezius muscles. KQ 11.3 In level IV dissection, the vagus nerve runs vertically between the common carotid artery (anteromedially) and the internal jugular vein (IJV) (posterolaterally). The phrenic nerve lies over the scalene muscle, which forms the floor of the level IV dissection. In level V dissection, the spinal accessory nerve (SAN) can be preserved by identifying the posterior border of the sternocleidomastoid (SCM) muscle, Erb’s point, and trapezius muscle following adequate subplatysmal and skin flap elevation.