A modified dissection method to preserve neck structures

Abstract

The neck is not only one of the more challenging anatomical regions to dissect but also has important application to clinical conditions, diseases, and procedures. In this study, we describe two simple modifications for dissection of the neck that (1) aid in the identification and preservation of the cutaneous branches of the cervical plexus and the accessory nerve, and (2) provide wide exposure of the root of the neck. The cutaneous branches of the cervical plexus can be identified with relative ease at the nerve point of the neck, where they are largest. To accomplish this, the skin and platysma are reflected beginning from the anterior border of trapezius and proceeding anteriorly to the midline of the neck, rather than the conventional approach of reflecting the skin from the anterior midline. The accessory nerve is identified by its relationship to the nerve point and its course to the trapezius muscle. To achieve wide exposure of the root of the neck and its contents, the acromioclavicular and sternoclavicular joints are disarticulated, and then the clavicle removed completely, rather than the more common approach of removing only the middle section of the clavicle. These modified procedures can be readily performed by first-year medical students and integrate well with methods described in widely used anatomy dissection manuals.

Approach for recurrent thyroid carcinoma with a clavicle osteotomy

“…In few selected cases, total removal of the clavicle is also feasible to provide an excellent exposure and preserve all important neurovascular structures at the root of neck. This provides good access to the subclavian vein, the costocervical trunk, dorsal scapular artery, supraclavicular part of brachial plexus, common carotid artery, internal jugular vein, vagus nerve and the phrenic nerve 8 .…”