Dissection of the muscle layers

Question 1

First layer: Instructor: What’s the first muscle layer you’ll encounter after the incision and how do we identify it?

Answer 1

After the skin, the platysma. It’s a thin, superficial layer just under the skin, with oblique oriented fibers across the neck.

Question 2

First layer: Instructor: How do you develop surgical access at this stage?

Answer 2

→ Trainee: “I will create subplatysmal flaps, elevating them all the way superiorly to the inferior border of the mandible and inferiorly to the hyoid bone. This provides a clear and wide surgical field.”

Question 3

Second layer: Instructor: Describe the next structure you’ll see.

Answer 3

Trainee: The paired anterior bellies of the digastric muscles. They are oval shaped and located symmetrically on each side of the midline.

Question 4

Second layer: Instructor: What’s your approach?

Answer 4

Trainee: Retract them laterally to expose deeper layers without cutting them.

Question 5

Third layer: what comes next and what are its characteristics

Answer 5

Mylohyoid, is a thin, flat muscle characterized by transverse fibers that unite along the midline.

Question 6

Third layer: Instructor: How will you proceed?

Answer 6

Trainee: I will perform a midline dissection from mandible to hyoid bone of the mylohyoid muscle to create space and retract it laterally. I will apply two sutures to ensure accurate anatomical reorientation during the procedure and facilitate easy muscle closure postoperatively.

Question 7

Forth layer: Instructor: what is the next layer and what do you notice about it?

Answer 7

Trainee: geniohyoid, It consists of vertical fibers, attaches to the hyoid bone, and is typically thick and robust, positioned underneath mylohyoid muscle.

Question 8

Fourth layer: Instructor: What’s your approach?

Answer 8

Trainee: Bluntly dissect along the midline and retract it laterally.

Question 9

Fifth layer: instructor, what is next and what are the structural features

Answer 9

Trainee: Genioglossus, Trainee: The muscle features vertical fibers, a fatty raphe located between the genioglossus bellies, an attachment point at the mandible, and is generally paler in appearance compared to the geniohyoid

Question 10

Fifth layer: Instructor: How do you expose it?

Answer 10

Trainee: Perform blunt dissection of the geniohyoid to expose the genioglossus, taking care to preserve the fatty midline raphe and ensure clear access to the lateral borders of the genioglossus muscle.