HEAD AND NECK

1. Incision planning.

2. Skin and platysma incision.

3. The external jugular vein and the great auricular nerve are discerned.

4. Elevation of the fascia of submandibular salivary gland.

5. An enlarged lymph node in contact with the submandibular gland.

6. Dissection along the inferior border of the mandible.

7. Dissection and ligation of the facial vein. The marginal mandibular branch is discerned above.

8. Elevation of the submandibular gland. The anterior belly of the digastric muscle and the mylohyoid muscle are discerned.

9. The lingual nerve is discerned.

10. The hypoglossal nerve is discerned.

11. Transection of the submandibular ganglion.

12. Wharton’s duct dissection.

13. Dissection in progress. Elevation of the lower skin flap in order to dissect along the anterior border of the sternomastoid muscle and locate the accessory nerve.

14. Retraction of the sternomastoid and elevation of the carotid sheath. The internal jugular vein is discerned surrounded by lymph nodes. Posteriorly, the accessory nerve is seen.

15. After locating the accessory nerve the dissection of the specimen proceeds posteriorly. The facial artery is ligated.

16. The specimen is inferiorly retracted. The submandibular triangle, as well as the intermediate tendon of the digastric and the stylohyoid muscle are discerned.

17. Retraction of the sternomastoid and the posterior belly of the digastric. Dissection of the posterior neck triangle. The accessory nerve and the occipital artery are discerned.

18. Suture ligation of the common facial vein.

19. The hypoglossal nerve and the descending hypoglossi are discerned.

20. The vagus nerve is seen between the jugular vein and the carotid artery.

21. The inferior limit of the neck dissection. The omohyoid muscle is seen at the tip of the scissors.

22. Ligation of the middle thyroid vein.

23. The surgical specimen is posteriorly retracted with forceps. The attachments in the region of the strap muscles are divided.

24. The specimen is ready to be removed. The superior thyroid artery is just discernible between the arms of the forceps.

25. The operative field after the removal of the specimen.