Neck Dissection - Level 1
Considerations
Anatomy
marginal mandibular nerve
digastic muscle
mylohyoid muscle
submandibular ganglion
lingual nerve
submandibular gland and submandibular duct
hypoglossal nerve
Indications
Preparation
Procedure
Identify the marginal mandibular nerve and elevate it, along with the surrounding tissue, in its own plane
Remove the submental fatty tissue and identify the anterior belly of the digastric muscle
Follow the anterior belly of the digastric muscle and identify the mylohyoid muscle
Retract anteriorly the mylohyoid and expose the submandibular ganglion, lingual nerve, and submandibular duct
Divide and ligate the submandibular duct
Clamp, divide, and ligate the facial artery's feeding vessels into the submandibular gland (SMG) as well as the veins draining the SMG
Remove the SMG and the submandibular lymph nodes
Identify the hypoglossal nerve deep into the fascia of the submandibular triangle
Identify and expose completely the posterior belly of the digastric muscle up to the mastoid tip
Optional: If the facial artery is reencountered at this point, tie it and ligate it
After completion of all of the above, dissect and displace inferiorly the submental fatty tissue, submandibular nodes, and submandibular gland
Sample operative report
The skin was incised through skin and subcutaneous tissue and platysma muscle. A subplatysmal flap was raised a short distance superiorly. The inferior edge of the submandibular gland was identified and the fascia overlying the gland was then elevated off of the gland. The flap was elevated to the inferior aspect of the mandible. The soft tissue of the submandibular gland and its soft tissue contents were elevated away from the mandible. The soft tissue between the anterior bellies of the digastric was dissected out with a Bovie electrocautery and reflected toward the lateral aspect of the neck. The specimen was rolled onto the mylohyoid muscle and then onto the digastric musculature. The digastric muscle was retracted and the hypoglossal nerve was identified and preserved. The lingual nerve was identified and preserved. The submandibular duct was clamped, divided and ligated. The submandibular ganglion was clamped, divided and ligated. The facial artery and facial vein were identified and traced out and preserved. The attachments of the submandibular gland were divided as well as the small feeding branches of the vein and artery into the gland. The gland along with its accompanying fibrofatty/nodal issue were reflected further onto the lateral aspect of the neck. The posterior belly of digastric was followed and traced superiorly to complete the level 1 dissection.
Post-op
Complications