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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.