About Video

This video demonstrates the steps of a modified neck dissection. It takes one through the various levels of lymph nodes as well as the methods to preserve uninvolved structures that are vital for a good postoperative outcome. The choice of incision depends on a variety of factors including the indication for the neck dissection, whether the patient has received preoperative radiation therapy as well as the surgeon’s preference. Also, the upper limb of the incision may be incorporated/extended/modified according to the need as required for the resection of the primary growth. This is especially applicable during resection of oral/oropharyngeal malignancies. After elevation of subplatysmal flaps, it is important to preserve the marginal mandibular branch of the facial nerve to achieve good postoperative cosmetic results. An exception is made when the level 1b lymph nodes are involved or if the angle of the mouth itself is involved with the malignancy. The dissection may proceed from the submental region to the supraclavicular, or the reverse, depending upon the indication and the surgeon’s preference. Serial levels of the lymph nodes are then cleared, preserving the internal jugular vein and the spinal accessory nerve, if oncologically permissible. Removal of the sternomastoid muscle is again a matter of preference, and occasionally its upper end may be left attached so as to rotate it into the defect, especially when there is a large communication between the oral cavity and the neck, in cases where there has been excessive dissection of the floor of the mouth. The course of the spinal accessory nerve and internal jugular vein have also been demonstrated.