- Levels II to V
- In the context of thyroid cancer do the lateral neck dissection first - vagus will be on display which makes it easier to find circuit
- Incision
- Many different incision
- I extent the total thyroid incision across
- Options are step ladder incision or vertical extension
- Raise flaps
- I would start with level 2
- Level 2
- 2A
- Protect the great auricular nerve and marginal mandibular branch of the facial nerve at superior flap
- Blunt dissect behind the posterior border of the submandibular to find the post border of post digastric
- Diathermy on to it - that is your anterior limit of level 2a
- Identify and preserve the Hypoglossal Nerve
- Open the fascia around SCM - dissect under it and retract it laterally
- Once you get close to the tendon of SCM on the medial aspect I am near the accessory nerve
- Blunt dissect to find it and then follow it up
- Once you have IJV, hypoglossal and Accessory on view you can then clear everything anterior to it
- 2B
- Can take this if requried but often not down for thyroid
- This just superior to accessory
- Level 4
- Dissect the down along the medial border of SCM
- To the level of the clavicle
- Clear all tissue superiorly above the Scalenus Anterior fascia
- Level 3
- Connect the two dissections remove level 3 nodes
- Level 5
- Identify the Accessory Nerve at the posterior border of SCM
- Take the issue inferior and superior to it between SCM and Trapezius