Schwannoma of the Sympathetic chain
1. Planning the incision. | 2. Incision of the skin, the subcutaneous tissues, the platysma. Elevation of the upper skin flap. |
3. Identification, division, and ligation of the external jugular vein. | 4. Elevation of the lower skin flap. View of the sternomastoid muscle and the greater auricular nerve. |
5. Dissection along the anterior border of the sternomastoid muscle. The muscle is widened due to pressure from the tumor. | 6. Continuation of the dissection. The internal jugular vein is identified. |
7. Retraction of the sternomastoid. Identification of the tumor and the vagus nerve on its surface (at the tip of the scissors). | 8. Continuation of the dissection. Clear view of the tumor, the vagus nerve, and the internal jugular vein. |
9. Identification of the digastric muscle and the hypoglossal nerve at the upper part of the surgical field (beneath the retractor). | 10. Identification of the descendens hypoglossi and the common carotid artery. |
11. The common carotid artery is seen at the anterior border of the tumor. | 12. Dissection of the inferior border of the tumor. Identification of the nerve of origin of the tumor (the sympathetic chain). |
13. Division and ligation of the sympathetic chain. | 14. Trying to mobilize the tumor with blunt dissection.. |
15. Dissection and mobilization of the superior border of the tumor. View of the hypoglossal nerve. | 16. A large feeding vessel is identified at the superior border of the tumor. |
17. Dissection along the superior border of the tumor and mobilization of the vessel. | 18. Division and ligation of the feeding vessel. |
19. Almost complete mobilization of the tumor which is hanging from its superior stem. | 20. The surgical field after the removal of the tumor. |
21. The surgical specimen. |