L5.2 Neck dissection

Question 1

What are the main steps in the surgery

Answer 1

1. position patient
2. draw on surface anatomy
3. First cut into the superficial fascia to expose as much area as possible and find the boundaries of the triangle
4. Identify important structures:
   Int Jugular vein, Spinal accessory nerve

Question 2

What are the 3 sites where you find the spinal accessory nerve

Answer 2

1. Up higher it leaves the posterior triangle to ant triangle. It should be running on top of the int jugular vein underneath the digastric muscle
2. On average it is 1.5 cm above the where the Great auricular nerve exits erbs point
3. At bottom it runs across the post triangle and goes into the anterior border of trapezius

Question 3

What causes a chyle leak

Answer 3

Damage to the thoracic duct which can sit in ant or posterior triangle behind the int. jugular vein on the left.