Posterior neck mass
Considerations
Patient positioning
Important to coordinate with Anesthesia regarding the appropriate position for the patient
Most posterior neck masses will require patient in prone positioning for adequate exposure
Work with OR nurse to find appropriate bumps, padding for patient
General vs local with MAC anesthesia
Again, both are options but the tumor and the patient's preference factor into the type of anesthesia
Often the patient is choosing to have the procedure done under GA
Drain or no drain
This is usually a game time decision, but be aware that you will likely need a passive or closed suction drain
Most large posterior neck masses will form seromas if not properly closed
The suture technique is critical to seroma prevention
Drains are needed when dead space is present despite proper suture technique
Preparation
Optional: Ultrasound - to determine if mass is deep to muscle, and size of mass
Mark the incision site
A horizontal incision at least the length of the mass is ideal
Infiltrate 10-30 ml of 1% Lidocaine with 1:100,000 epinephrine
Hydrodissect the place directly superficial to the mass and around the periphery
Standard sterile prep and drape
Procedure
Sample operative report
Findings:
- *** posterior neck *** cm fatty tumor in the subcutaneous plane
- Performed complete excisional biopsy via *** cm horizontal neck crease incision, layered closure to obliterate wound dead space, *** Penrose drain placement
Procedure in Detail:
PARC of procedure was explained to patient in ASU who agreed to proceed. Patient was brought into the room and laid on the OR table. Time out was performed with all OR staff.
GETA was applied. The *** cm incision was marked, oriented in an inferior horizontal neck crease. After cleaning the skin, local anesthesia was applied; 15 ml of 1% Lidocaine with 1:100,000 Epinephrine was injected. Sterile prep and drape completed.
Incision made with 15 blade scalpel through the dermis. Dissection in the immediate subcutaneous plane was completed over the mass. The dissection was continued around the mass, which appeared fatty with an *** indiscrete capsule, taking care to avoid surrounding normal subcutaneous fat and deep muscle. The mass, which measured ~ *** cm in its widest dimension was removed in its entirety. Once removed, the mass was sent to Pathology as a permanent specimen. Irrigation completed. Hemostasis maintained with Bovie and Bipolar.
Wound closure with 3-0 Polysorb deep buried suture in the deep muscle and connected with deep dermal layer to approximate the dermis. A single 1/2 inch Penrose drain was placed exiting from the central incision, secured with 3-0 Prolene. The epidermis approximated with 5-0 Fast. Skin cleansed and Fluff dressing applied, secured with Foam tape for light compression.
Anesthesia discontinued; Patient awoken. Count correct. Patient moved to PACU in stable condition.