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This seminar explains about the development, relations, ligaments, various attachments, vascular and nervous supply and various surgical approaches and its modifications to TMJ
This seminar explains about the development, relations, ligaments, various attachments, vascular and nervous supply and various surgical approaches and its modifications to TMJ
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
6. Excision of same lymph
node bearing regions
as RND with
preservation of one or
more nonlymphatic
structures (SAN, SCM,
IJV)
Modified Radical neck dissection
7. MRND Type I
Preservation of SAN
MRND Type II
Preservation of SAN
and IJV
MRND Type III
Preservation of SAN,
IJV, and SCM
11. • Painting and draping.
• Positioning of the patient.
• Choose appropriate incision according to the surgeon
preference.
• Adequate exposure and therefore suitable access to
the complete operative field.
Generic steps for all neck dissections
12. • The patient typically is in the supine position,
with
the head and chest elevated to 30°.
• The neck is hyperextended and turned to the
contralateral side.
Patient positioning
13. • Good exposure of the neck and primary disease
• Ensure viability of the skin flaps. Avoid acute angles
• Protect carotid artery even in the cases of wound infection
• Facilitate reconstruction
• Adapt to the condition of patient esp after radiotherapy
• It should be cosmetically acceptable
Basic needs of an incision are
14. • Incisions classified into
– Vertical
– Horizontal
Incisions
Transverse incision Vertical incision
Have cosmetic advantage as
they follow natural skin
folds of the skin
Disadvantages because they
intersect to the natural skin
folds of the skin and the
vascular supply of the neck
Recovery of scar tissue in
these folds are rapid and
successful
They tend to contract along
their long axis – leads to
deformity and restricted
action
Easy to modify
15. • Advantages
– Incision provides good exposure to surgical
site.
• Disadvantages
– Flap necrosis is high due to disruption of
vasculature of skin flaps
– Occurrence of flap separation at the
trifurcation site.
• Variations of classical Y incision – gluck,
schobinger, conley, martin incision.
• Other alternatives : utility incision, hockey
incision, apron flap, Mcfee incision
Tri-radiate incision
16. Apron incision
A horizontal incision from mastoid to
mentum gently curving inferiorly upto upper
border of the thyroid cartilage is used.
• Advantages
– Carotid artery is well protected
– Protects the descending arterial recovery
• Disadvantages
– It will damage the ascending arterial and
venous recovery
– Venous congestion and oedema might
develop at the bottom corner
17. Half Apron incision
• It has a longitudinal and transverse
incision
• B/L hockey stick incision allows the
deglovement of the whole neck.
18. It is a paired ‘Y’ incision.
• Here the submandibular
component is met by a vertical
limb which below becomes
continuous with an inverted ‘Y’ in
the suprascapular region.
• This flap most often gets
cyanosed.
• Flap necrosis and carotid
exposure is more in this type of
incision.
Hayes Martin incision
20. • It avoids a vertical limb.
• Two horizontal incisions are used one in submandibular region and other in the suprascapular region.
McFee incision
Advantages Disadvantages
Excellent cosmetic result Exposure is not good
There is no lessening of
vascularity in
the centre of the flap
It is not suitable for bilateral
simultaneous neck dissection
There is no angle intersection
in incision
Operating period is long
Post operative wound recovery
is rapid
Difficulty may arise while
working
under the bridge flap
Recovery of flap excellent due
to wide
bipedicled flaps
In short neck it might be
difficult
21. • Incision – blade no.10 through skin down to the
platysma fibers.
• Platysma muscle ensures appropriate blood supply to
the skin flap and also increases the strength of the
wound in the postoperative period.
• Removed only if invaded.
• Rake retractor or double skin hooks used to retract
platysma.
Generic steps for all neck dissections
22. • During the dissection of upper
neck, two branches of facial
nerve should be preserved.
– Marginal Mandibular Nerve
– Cervical Branch
• Both nerves curve downwards
below and in front of the angle of
the mandible across the facial
vessels about one finger’s
breadth below the mandible.
Generic steps for all neck dissections
23.
24.
25. • Easiest way save these
nerves is expose the capsule
of the lower part of the
submandibular gland.
• The fascia can then be
elevated as a flap over the
mandible taking the nerve
with it.
• Then the flap is sutured
superiorly.
Generic steps for all neck dissections
26. 4 areas of special
attention during neck
dissection
1. Lower end of IJV
2. Junction of lateral border of
clavicle with lower edge of
trapezius
3. Upper end of IJV
4. Submandibular triangle
27. Indications for a classical radical neck dissection
1. Significant operable neck disease with
tumour bulk near to or directly involving spinal accessory
nerve and/or internal jugular vein.
2. Extensive recurrent disease after previous selective
surgery or radiotherapy.
3. Clinical signs of gross extra nodal disease.
RADICAL NECK DISSECTION
28. Contraindications for a classical radical neck dissection :
1. Untreatable primary tumor or unresectable neck
disease.
2. Patient unfit for major surgery.
3. Distant metastases
4. Simultaneous bilateral neck dissection.
RADICAL NECK DISSECTION
29. • The lower end of the
internal jugular vein is
approached first by
continuing dissection
along the upper border
of the clavicle from
trapezius muscle to the
suprasternal notch.
First area of special attention : the lower end of the IJV
30. • The supraclavicular nerves and
vessels are divided as well as
the sternocleidomastiod
muscle.
• The internal jugular vein lies
between the sternal and
clavicular heads of the
sternocleidomastiod muscle
and dividing the muscle fibres
just above the clavicle reveals
the vein.
31. • This can be done by using
blunt-tipped scissors,
isolating the muscle by
pushing the scissors under
the sternocleidomastiod
muscle and then keeping
the scissors in place to
protect the underlying
vein, the muscle can be
cut.
Dharamshila Narayana Hospital
32. • After dividing the sternocledomastoid
muscle, the blueness of the internal
jugular vein can be seen as
• The vein lies within the carotid sheath.
Dharamshila Narayana Hospital
33. • The carotid sheath is opened and
the IJV is exposed for at least a few
centimeters in order to allow for
adequate access for ligation.
• The position of the vagus nerve is
verified before ligation of the
internal jugular vein.
• Three ligating sutures, are placed
around the vein, upper end of the
vein and lower end of the vein.
34. • Tansfixation suture on
lower end is known as
HOUSEMAN’s SUTURE
(since, if it fails in the
early hours of the
morning following
surgery, it is the
houseman who knows
about it first)
• The bleeding injured
vessel should be
identified and occluded
temporarily with pressure
or arterial clamps and the
defect repaired using 6.0
Ethilon. Dharamshila Narayana Hospital
35. When performing a neck
dissection on the left side of the
neck, one should be alert between
the IJV, subclavian vein and the
clavicle because of the thoracic
duct.
After ligation of the vein, the
carotid artery and vagus nerve are
carefully retracted medially
allowing for dissection of the IJV
and its associated lymph node.
36. • Once the IJV has been tied the
dissection extends laterally towards
Chaissaignac’s triangle.
• It’s defined as the triangle between
where the longus colli and scalenus
anterior attach to the tubercle of C6
(Chaissaignac’s or carotid tubercle)
with the subclavian artery as the
base.
• Here are found scalene node which
should be removed.
• Main jugular lymph duct that
terminates here on the left side
with the thoracic duct.
• If the duct damaged, noticeable by
extra clear fluid welling up into the
dissection area, the source should
be found and transfixed.
37. Second area of special attention: Junction of clavicle and
anterior border of trapezius
38. • Deeper to the omohyoid, the
transverse cervical artery and vein
are found as they run laterally
across the floor of the posterior
triangle and ligated.
• Both the artery and particularly the
vein have small branches across the
anterior border of trapezius muscle.
• Dissection is then continued
further, either sharp or blunt with a
swab, on to the underlying level of
the prevertebral fascia overlying
the scalene muscle.
39. • Directly under
prevertebral fascia ,
the phrenic nerve
and the brachical
plexus are seen.
• As long as the
fascia is not
breached, these
structures are
protected.
• Once the
supraclavicular
dissection has been
completed towards
the anterior border
of trapezius, the
operation
continues in an
upwards direction
to dissect the
posterior triangle.
40. • The dissection continues
upwards following the
anterior border of the
trapezius muscle to the
uppermost point of the
triangle at the mastoid tip
where the trapezius and
sternocleidomastoid meet.
Dissection of the posterior triangle
41. • The anterior border of the trapezius muscle represents the lateral border
of the dissection.
• Floor of the posterior triangle is formed by the prevertebral fascia overlying
the deeper muscles of the neck- the splenius capitis (cranially), medial,
anterior and posterior scalenus muscles and the levator scapulae.
• It is important before dissecting the posterior triangle that the SAN is
identified.
• There are a number of ways to identify the nerve, based on its anatomical
trajectory and surgical landmarks.
42.
43. • This is known as Erb's point and
can be identified 1 cm above the
point where the Greater Auricular
Nerve winds around the muscle on
its way to supply the parotid fascia.
• Once identified, the nerve may be
mobilized.
• The dissected tissue now hinges on
the mastoid and skin insertions of
the sternocleidomastoid muscle;
these are dissected as well as the
lower lobe of parotid gland at the
level of the angle of the mandible.
44.
45.
46. • Divided the upper end of the
sternocleidomastoid muscle in the
third area.
• Retract the posterior belly of
digastric muscle upwards.
• Posterior belly of digastric muscle
as known as resident’s friend – is
cleared and using a Langenback
retractor, it can be retracted
superiorly exposing IJV and
accessory nerve.
Third area of special attention: The upper end of the internal
jugular vein
47. • Before tying any ligatures, the Vagus and Hypoglossal Nerves should be
identified and preserved.
48. The Occipital Artery crosses the
Posterior Part of the Internal
Jugular Vein and this should also
be ligated now to prevent
further troublesome bleeding.
49. • Upper end of the internal
jugular vein identified and
ligation done
• Dissection across the
carotid bifurcation may
cause bradycardia and
changes in blood pressure
due to triggering of the
carotid sinus lying within
the bifurcation.
• Once the IJV has been
ligated and dissected at the
upper end, the surgical
specimen is mobilized.
• Dissection continues
anteriorly along the border
of the mandible.
50. • The contents of the triangle,
including lymph nodes and fatty
tissue must be removed leaving
behind clean muscles that form
the boundaries.
• Dissection of the submandibular
triangle is usually begun in the
midline, by dividing the fatty
tissue on to the dissection plane
of the anterior belly of the
contralateral digastric muscle.
Fourth area of special attention: the
submandibular triangle
51. • The anterior part of the
submandibular gland is
identified and is
dissected to the
posterior border of the
mylohyoid muscle.
• The upper border of the
submandibular gland is
freed by tying and
dividing the vessels,
including the facial
artery, that cross the
lower border of the
mandible
52. • The mylohyoid muscle is retracted in a forward direction to reveal the
submandibular duct and, at this point, the lingual nerve is pulled down in a
curve.
• The latter is freed by dividing the fascia around the submandibular
ganglion.
53. • The lingual nerve is identified, and
two artery forceps are placed below it
to divide the branch to the
submandibular ganglion.
• The submandibular duct is tied and
divided and during both of these
procedure, the hypoglossal nerve is
kept under direct vision to avoid any
damage.
54. • Two large drains are placed through the posterior flap and securely
tied.
• Drains should never cross the carotid sheath, be cut to the correct
length and kept well away from any microvascular anastomosis.
• Finally, make a check for any chylous leak, any bleeding from the veins
accompanying the hypoglossal nerve .
• The wound is closed in two layers with an absorbable Vicryl stitch to
the platysmal layer and the skin then closed using either interrupted
or continuous sutures of Ethilon.
Closure
55. • Modifications of the classic RND aim to reduce postsurgical neck pain
and shoulder dysfunction encountered when the spinal accessory is
resected without compromising adequate oncologic treatment.
• Sacrifice of the SCM and IJV is less debilitating.
• SCM preservation - improves cosmetic appearance and protects the
carotid artery if adjuvant radiotherapy is employed.
• Preserving the IJV becomes more significant in patients requiring
bilateral neck dissections.
Modified radical neck dissection
56. If the accessory nerve is to be
preserved , extra care should be
taken when the skin flap of the
posterior triangle is developed, as
the nerve runs at a superficial
level and is therefore close to the
plane of dissection.
Preserving spinal accessory nerve
57. • Preservation of the sternocleidomastoid muscle requires mobilization
of the deep inserting fascia from the anterior border of the
sternocleidomastoid muscle and dissection of the muscle from the
fascia below allowing for upward retraction of the muscle using loops
or retractors.
• The dissection itself is continued under the sternocleidomastoid
muscle in the same way as one would proceed as in a radical neck
dissection.
Sparing of the sternocleidomastoid
muscle
58. • Prior to approaching the fascia of
the sternocleidomastoid muscle, the
external jugular vein must be ligated
and divided.
• Usually, three sections of the
external jugular vein are required in
functional and selective neck
dissection.
59. • Preservation of the internal jugular vein requires careful dissection
along the surface of the vein.
• As in radical neck dissection, the vein is located preferably first in the
lower neck, after having completed the dissection across the clavicle
from trapezius to suprasternal notch.
• The supraclavicular nerves and vessels (such as the external jugular
vein) are divided as well as the sternocleidomastoid muscle.
• The sternocleidomastoid lies directly over the internal jugular vein.
Sparing of the IJV
60. • Selective Neck Dissection consists of preservation of one or more
lymph node groups and all three nonlymphatic structures.
SELECTIVE NECK DISSECTION
Selective Neck
Dissection
Levels
dissected
Main Indications
Supraomohyoid
(SOHND)
I – III SCC oral cavity
Extended
supraomohyoid
I – IV 1. Skin Ca (SCC,
Melanoma) anterior
to line of tragus.
2. Performed in
Conjunction to
superficial
parotidectomy
61. Selective Neck
Dissection
Levels
dissected
Main Indications
Lateral II – IV SCC larynx,
Oropharynx and
Hypophaynx
Posterolateral II – V plus Post.
Auricular
Skin Ca (SCC, Melanoma)
posterior to line of tragus
Anterior /
Central
VI Differentiated Thyroid
Ca, Subglottic,
Hypopharyngeal SCC
Superior
Mediastinal
VII Differentiated and
Medullary Thyroid Ca
,Subglottic, Laryngeal,
Hypopharyngeal SCC 3.
Cervical Oesophageal Ca
62. • SOHND is indicated in patients with primary tumors arising from the oral
cavity without clinical or radiologic evidence of cervical metastasis but who
have a high probability of occult lymphatic disease.
• The oral cavity includes the area between the vermillion border of the lips
and the junction of the hard and soft palate superiorly and the
circumvallate papillae of the tongue inferiorly.
• Bilateral SOHND is indicated in patients who have carcinomas of the
anterior tongue or oral tongue and floor of mouth that approach or cross
the midline.
• SOHND is indicated along with parotidectomy in patients with squamous
cell carcinoma.
INDICATIONS OF SUPRAOMOHYOID TYPE
66. • Treat by opening and elevating the neck flaps to evacuate the hematoma.
• Irrigate the surgical field with isotonic sodium chloride solution, and, if any source of bleeding is found,
ligate, suture, or electrocauterize to achieve hemostasis.
• If the hematoma is recognized and treated early, no adverse consequences ensue.
• However, if found late, airway compromise, infection, or flap necrosis can occur.
HEMATOMA
• Use suction drains to avoid accumulation of blood under the skin flap and to prevent hematoma
formation.
• Sudden bleeding indicates that an untied vessel has opened or that a ligature has slipped from the
vessel.
67. • Salivary contamination from the oral cavity is possible, causing
bacterial invasion and wound infection.
• Other factors are malnutrition, chemotherapy, anemia, diabetes
mellitus, and advanced tumor mass.
WOUND INFECTION
• If wound infection develops, open the flap, evacuate and culture the pus, and irrigate the
wound.
• Administer antibiotics.
• Carefully debride necrotic tissue.
• Local care with frequent dressing changes, salivary fistula control, and wound irrigation is
critical.
68. • Skin flap necrosis causes design errors, elevation, poor handling, or improper
postoperative care.
• Preexisting scars, prior radiation therapy, hematoma, infection, and poor nutrition
can contribute to skin flap loss.
• Carefully and progressively trim necrotic tissue and frequently change wound
dressings.
• Skin necrosis, infection, and accumulation of pus adjacent to the carotid wall alert
the surgeon to a potential carotid artery rupture.
SKIN FLAP LOSS
69. • Carotid artery rupture is rare after supraomohyoid neck dissection.
• Incidence of this complication ranges from 3-7%. The precipitating factors of carotid artery rupture
are as follows:
• Radiation therapy
• Infection and salivary fistula
• Suction catheters that cause erosion of the vessel wall
• Exposure by dehiscence of the suture line or necrosis of the dermis
• Rupture occurs in patients who underwent neck surgery with exposure of the carotid artery
and one or more of the precipitating factors listed above.
• Initial bleeding indicates that serious complications can be avoided with elective ligation of
the offending artery.
CAROTID ARTERY RUPTURE
70. Immediate treatment for carotid artery rupture
includes the following measures:
• Apply direct and firm pressure to the affected area.
• Suctioning, good illumination, and adequate instrumentation are imperative.
• With a large-bore catheter, cannulize a peripheral vein in each arm for immediate administration of
fluids
• The airway should be adequate and stable.
• If the patient does not undergo a tracheotomy, orotracheal intubation may be necessary.
• Blood is typed and cross-matched for 4-6 units of blood.
• Move the patient to the operating room.
• If bleeding cannot be controlled with pressure, clamp the common carotid artery as an emergency
procedure.
71. Definitive treatment for carotid artery rupture
includes the following measures:
• Ligate the carotid artery.
• Adequate exposure (both proximally and distally) to the source of bleeding and
contaminated or infected areas helps prevent a second rupture.
• Accomplish ligation with 1-0 silk suture. Reinforce this suture, distally and
proximally, with 2-0 silk suture. Then, bury the ligated stump in surrounding
healthy tissue.