Suprascapular hyoid lymph node dissection

Surgical treatment of oral and maxillofacial malignancies. Malignant tumors originating in the head and neck and oral and maxillofacial regions, the metastasis pathways mostly through the lymphatic system, first manifested as the metastasis of the cervical lymph nodes. These cervical lymph node metastases are not sensitive to radiation and chemical drugs, and the treatment effect is often Not ideal enough. Cervical lymphadenectomy is an indispensable and effective method for curing malignant tumors of the head and neck and oral and maxillofacial regions. Clinically, the scope of lymphadenectomy is often determined according to the specific analysis and research of the patient's systemic and local conditions and the presence or absence of metastases. The name is based on the scope of lymphatic dissection, limited to the submandibular area, the upper part of the hyoid bone is called the upper lingual lymphadenectomy; the surgery is limited to the scapular scapula above the scope of the upper scapular lymphatic dissection; All neck lymph nodes are called full neck dissection. Total neck dissection is limited to one side, which is called a one-sided neck dissection; while bilateral surgery is called bilateral neck dissection (regardless of one operation or staged surgery). If the neck dissection and surgical resection of the primary tumor are surgical resection, it is called combined radical surgery. In addition, clinically, cancerous tumors with high degree of malignancy, poor differentiation, and rapid development of the disease, even if no lymph nodes with enlarged metastasis are found, cervical lymphadenectomy is performed. This type of surgery is called selective lymphadenectomy. Conversely, lymphatic dissection after clinically confirmed or highly suspected cervical lymph node metastasis is called therapeutic neck dissection. Treatment of diseases: oral and maxillofacial tumors Indication Scapular supracondylar lymph node dissection is applicable to: 1. The primary tumor of the maxillofacial malignant tumor has been surgically cut, or can be controlled. The cervical lymph node metastasis is in the N1, N2a, and b state of the UICC TNM classification, and is limited to the scapular humerus and may be removed. Case. 2. The volume of malignant tumors and lymph nodes in the submandibular and upper neck is large, and the submandibular and cervical lymph nodes are in the N1 and N2 phases, but the range is not more than the upper neck. 3. The above two cases combined with contralateral upper cervical lymph node metastasis (N2c), can be considered as bilateral scapular humeral lymphadenectomy. Contraindications 1. The primary tumor of the cancer cannot be completely removed by surgery or treated by other methods that cannot control its development. 2. Head and neck malignant tumors with high degree of malignancy, low degree of differentiation or prone to cervical lymph node metastasis. 3. The range of cervical lymphatic metastasis has exceeded the area of the scapula. 4. The general condition is poor and cannot tolerate the operator. Preoperative preparation 1. Regular body examination. 2. Local anesthetic and antibiotic allergy test. 3. Regular preparation of skin. 4. Match the blood if necessary. 5. Necessary supportive therapies to improve the body's resistance. Surgical procedure Incision Take a flat arc-shaped incision on the upper edge of the neck of the neck, and then descend to the mastoid, front to the middle of the ankle. For bilateral lymphadenectomy of the scapula, the incision extends from the lower part of the mastoid to the upper edge of the hyoid bone and then to the lower part of the contralateral mastoid. In order to fully reveal the field in the clinic, an auxiliary incision of an appropriate length can also be made vertically at the midpoint of the curved incision on one side. 2. Flap The skin, subcutaneous tissue and platysma are cut open, and the deep side of the muscle is dissected up and down along the incision, up to the lower edge of the mandible, down to the plane of the hyoid bone. 3. Cleaning lymphoid tissue The sternocleidomastoid muscle is exposed and pulled to the outside, and the lymphatic and honeycomb tissues between the internal jugular vein and the carotid artery bifurcation are removed, and then the submandibular and underarm tissues are removed, and the submandibular triangle and the armpit are removed. The triangular contents (the method and attention point are the same as the suprapubic lymphadenectomy), and they are continuous with the lymphatic tissue of the carotid triangle, and the parotid caudal lobe should be removed. 4. Stitching and dressing Rinse the wound, completely stop bleeding, layer suture, place negative pressure drainage or half tube rubber drainage strip, and dress up with sterile dressing. complication 1. For accidental injury to the nerve, it should be timely and consistent, and symptomatic treatment after surgery. 2. Accidental injury to important blood vessels in the neck must be properly treated. The internal jugular vein or external carotid artery injury can be ligated, and the internal carotid artery injury should be repaired.