Cerv 06

1. MODIFIED ANTERIOR APPROACH TO
CERVICOTHORACIC JUNCTION
1) Left-sided incision 1 – 2 inches proximal to clavicle; extending
vertically from medial edge to manubriosternal junction
2) Platysma incised in line with skin incision/ superficial veins
cauterized
3) Elevate manubrial and clavicular heads of SCM
subperiosteally
4) Strip remaining periosteum from medial clavicle and left
manubrium
5) Gigli saw to cut clavicle

2. MODIFIED ANTERIOR APPROACH TO
CERVICOTHORACIC JUNCTION
• Dissect interval between trachea/ esophagus and carotid
sheath
• Retract left carotid sheath, subclavian vein and
brachiocephalic vein inferolaterally to patient’s left
• Dissect prevertebral fascia

4. STERNOCLEIDOMASTOID
MUSCLE
Skin incision for anterior approach to the cervicothoracic junction.

6. STERNOCLEIDOMASTOID
CLAVICULAR HEAD
OMOHYOID
STERNAL HEAD
STRAP MUSCLES TRANSECTED
EXTERNAL
JUGULAR VEIN
PLATYSMA
The manubrial (sternal) and clavicular heads of the sternocleidomastoid
muscles have been elevated (transected) to expose the clavicle.

8. CAROTID ARTERY
VAGUS NERVE
INTERNAL
JUGULAR VEIN
PHRENIC NERVE
LATERAL RETAINED
CLAVICLE
SUBCLAVIAN VEIN
1st RIB
LEFT RECURRENT
LARYNGEAL NERVE
ESOPHAGUS
MANUBRIAL ARTICULATION
OF CLAVICLE
The medial third of the clavicle has been resected.

10. MIDDLE THYROID VEIN
THYROID GLAND
C7
T1
T2
Following vessel retraction,
the spine is exposed.
CAROTID ARTERY
LONGUS COLLI
INTERNAL
JUGULAR VEIN
BRACHIOCEPHALIC VEIN