The Smith/Robinson anterolateral approach involves making a transverse incision from the sternocleidomastoid muscle to the midline. The platysma is transected, exposing the sternohyoid muscle medially and sternocleidomastoid laterally. A longitudinal dissection is made through the pretracheal fascia to ligate the inferior thyroid artery and split the prevertebral fascia, elevating the longus colli muscles to expose the cervical vertebrae.

1. ANTEROLATERAL APPROACH –
SMITH / ROBINSON
1) Transverse (or oblique) skin incision from medial border of
sternocleidomastoid (SCM) muscle to midline
2) Platysma transversely transected, exposing sternohyoid m.
medially and SCM laterally
3) Omohyoid muscle retracted or divided

2. ANTEROLATERAL APPROACH –
SMITH / ROBINSON
4) Longitudinal dissection through pretracheal fascia (carotid
sheath laterally and tracheus and esophagus medially).
5) Inferior thyroid artery ligated (lower cervical spine)
6) Prevertebral fascia split longitudinally
7) Longus colli elevated off vertebrae

3. Oblique skin incision for the anterolateral
approach of Smith and Robinson.

5. PLATYSMA
The platysma is divided transversely.

7. MEDIAL LATERAL
PRETRACHEAL
FASCIA
CAROTID
SHEATH
The pretracheal fascia is divided medial to the carotid sheath.

9. COMMON CAROTID
STERNOCLEIDOMASTOID
PREVERTEBRAL MUSCLE RETRACTED
FASCIA OVER
LONGUS COLLI
MUSCLE
ANTERIOR
LONGITUDINAL
LIGAMENT
The prevertebral fascia is divided, exposing
the anterior longitudinal ligament.
ARTERY AND
INTERNAL JUGULAR
VEIN RETRACTED

11. OMOHYOID
TRANSECTED
LONGUS COLLI
MUSCLE
MIDDLE
THYROID VEIN
The anterior cervical vertebrae are now exposed.