This document discusses various incisions used for neck surgeries. It describes incisions for procedures like submandibular gland excision, parapharyngeal abscess drainage, thyroid surgery, tracheostomy, neck dissection, and total laryngectomy. Key factors in choosing an incision include exposure needs, tumor location, and avoiding previous sites. Common incisions mentioned are the transverse neck incision, modified apron incision, hockey stick incision, Kocher's thyroid incision, modified Schobinger incision, and Gluck Sorenson incision. Goals are adequate exposure, vascularization, inclusion of prior sites, and acceptable cosmesis.

1. NECK INCISIONS
DR G SRAVAN KUMAR

2. Lines of langer
1. Lines of skin tension
2. Topological lines drawn on a map of
human body.
3. Parallel to natural orientation of
collagen fibres in the dermis
4. Perpendicular to underlying muscle
fibres.

3. The choice for a specific incision is based on a variety of factors,
including
1. personal preference
2. previous radiotherapy or surgery,
3. the site of the primary tumour and its resection.

4. The following are the main goals that should be achieved by the skin
incision over neck:
1. assure adequate vascularization of the skin flaps
2. adequate exposure of the surgical field
3. consider the localization of the primary tumour
4. adequate protection of the major vessels
5. consider preoperative factors, such as previous radiotherapy
6. consider as well as facilitate reconstructive surgery, if needed
7. include previous surgical fields (scars, incisions for biopsies, etc.)
8. produce acceptable cosmetic results.

8. Submandibular gland excision
Transverse neck incision between
2 to 3 centimeters in length along
the inferior aspect of the
submandibular gland and
approximately 1 to 2 centimeters
inferior to the inferior border of
the mandible is made.

9. Parapharyngeal abscess
Two types of external approach
Modified apron incision -
● Used for exposure of submandibular
region and upper part of para-
pharyngeal space (levels I, II and III).
● The incision begins at submental
triangle curves downward two finger
breadth from the lower border of
mandible toward greater horn of
thyroid cartilage and extends across
sternocleido-mastoid. The incision can
be suitably modified according to
extent of abscess.

10. Hockey stick incision:
● Used for exposure entire PPS.
● Incision begins at mastoid tip and
extends across posterior triangle, then
curves sharply toward midline and
continues along anterior border of
sternocleidomastoid, ending just short
of sternoclavicular joint.
● The incision can be suitably modified
according to extent of abscess.

11. Thyroid incisions
Kocher’s thyroid incision:
Transverse “collar” incision, 2 finger
breadths above the suprasternal notch
from one sternocleidomastoid to another

12. Tracheostomy incision
The skin incision is made 2 cm below the
center of the cricoid cartilage to
exposure the inferior border of thyroid
isthmus

13. Neck dissection

14. Modified schobinger incision
- Modified Schobinger's incision is the most common incision used for
neck dissection.
- It has the advantage of adequate exposure and the incision can be
easily extended anteriorly as lip splitting incision in order to expose
the primary oral cavity tumor

15. Roy S, Shetty V, Sherigar V, Hegde P, Prasad R. Evaluation of Four Incisions Used For Radical Neck Dissection- A
Comparative Study. Asian Pac J Cancer Prev. 2019 Feb 26

16. Total laryngectomy incisions
● Gluck Sorensen incision
● Vertical incision
● T shaped incision
● Crime Y incision
● Trap door incision
● Double trap door incision
● Apron incision

17. Gluck Sorenson incision
● U shaped
● Stoma is incorporated into
incision
● Vertical limb is medial to medial
border of SCM
● Highest limit is the mastoid
process on both sides.

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