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Functional Neck Dissection

Modified Radical Neck Dissection type III

1. The incision. A block of metastatic nodes is noted. 2. Elevating the anterior flap.
3. The relation of the marginal mandibular branch of the facial nerve to the facial vessels. 4. Completion of the dissection of the submental triangle. Beginning dissecting the submandibular area.
5. Identification of the hypoglossal nerve medially to the digastric muscle. 6. Completing the dissection of the submandibular triangle.
7. Starting dissection along the jugular chain. The specimen of the submandibular triangle has been removed. 8. Descending hypoglossi and hypoglossal nerve.
9. Ligation of the common facial vein. 10. Identification of the omohyoid muscle.
11. Completion of dissection to the level of the omohyoid muscle. We can see the inferior root anastomosing with the descending hypoglossi, and the superior thyroid artery. 12. The same step of the operation but with an anterior and medial rotation of the specimen.
13. Continuing dissecting the specimen of the anterior neck triangle free towards the midline, the vagus nerve is revealed. 14. View after removal of the specimen. The ansa cervicalis is seen.
15. Elevating the posterior cutaneous flap. The trapezius muscle and the accessory nerve are seen. 16. While elevating the flap more cutaneous and muscular branches of the cervical plexus are revealed and must be distinguished from the accessory nerve.
17. At the posterior triangle, the accessory nerve is situated about one centimeter above and parallel to the great auricular nerve. 18. Furthermore, the accessory is situated at a higher level comparing to the branches of the cervical plexus.
19. Finally, the accessory nerve enters medially to the trapezius muscle comparing to the superficial cutaneous branches of the cervical plexus. 20. Mobilizing the accessory nerve.
21. Ligating the suprascapular artery. 22. Elevating the fibrous-fatty tissue from the supraclavicular fossa.
23. By continuing elevating the specimen, the phrenic nerve and the brachial plexus are revealed. 24. Elevating the specimen from the prevertebral muscles.
25. Continuing elevating the specimen from the phrenic nerve. 26. While elevating the fibrous-fatty tissue, two or three branches of the cervical plexus are divided.
27. One step before the completion of the dissection. 28. The surgical field after the removal of the specimen.