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General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
What are the boundaries and contents of the anterior triangle in the neck?Boundaries − midline, anterior border of SCM, lower border of the mandibleSubdivided into submental, submandibular, muscular and carotid trianglesContents − internal jugular vein, facial vein, retromandibular and external jugular vein, lymph nodes, hyoid bone, larynx, thyroid, parathyroid, carotid sheath, branches of external carotid artery, ansa cervicalis, and oesophagus
Surgery
Published in Seema Khan, Get Through, 2020
Carotid body tumours are located in the anterior triangle of the neck and present as a painless slow-growing lump in the neck. They are rare and usually benign lesions found at the bifurcation of the carotid artery. Surgical removal is advocated to prevent compression of neurovascular structures.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The boundaries of the posterior triangle of the neck are: posterior border of sternocleidomastoid, anterior border of trapezium, and the medial third of the clavicle. The roof is formed by investing fascia, platysma, and the external jugular vein. The floor is composed of prevertebral fascia covering muscles, subclavian artery, trunks of the brachial plexus, and cervical plexus. The carotid sheath is contained in the anterior triangle of the neck.
Levobupivacaine versus levobupivacaine – dexmedetomidine for ultrasound guided bilateral superficial cervical plexus block for upper tracheal resection and reconstruction surgery under general anesthesia
Published in Egyptian Journal of Anaesthesia, 2022
Hanaa M. El Bendary, Ahmed M Abd El-Fattah, Hisham A Ebada, Salwa MS Hayes
Anesthesia for repair of tracheal stenosis and reconstruction surgeries not only needs understanding the surgical procedures, but it needs also cooperation with the surgical team specially with surgical manipulations at the airway during resection and anastomosis and also the management of emergence and postoperative care [15]. So it is important to use techniques that optimize the immediate postoperative period and preventing too early or too late extubation and unwise use of postoperative opioid that results in immediate loss of the airway patency which increases the risk of reintubation but with difficult situation or it may lead to performance of emergent tracheostomy. As the superficial cervical plexus supplies the skin of the anterolateral neck via the anterior primary rami form the second to fourth cervical nerves so the SCP block considered as one of the techniques that causes anesthesia of the anterior triangle of the neck.
Prevalence of cystic metastases in a consecutive cohort of surgically removed branchial cleft cysts
Published in Acta Oto-Laryngologica, 2022
Lalle Hammarstedt Nordenvall, Evelina Jörtsö, Mathias von Beckerath, Edneia Tani, Sushma Nordemar, Rusana Bark
Branchial cleft cysts (BrCC) are congenital epithelial cysts. The majority of them (90%) arise on the lateral part of the neck from a failure of obliteration of the second branchial cleft [1]. They are the most common cystic lesion occurring in the neck and more than 75% present in the anterior triangle of the neck (regions IA, IB, IIA, III and IV) as a cystic swelling or lump. Regional metastasis from occult head- and neck squamous cell carcinoma (HNSCC), especially when occurring at region II to IV can mimic the BrCC as they both usually present as a swelling or lump in the neck [2,3]. Aside from HNSCC, papillary thyroid cancer (PTC) can also mimic a second branchial cleft cyst [4]. Several studies suggest a prevalence of enlarged HNSCC-metastases in 5–9.9% and lymph metastases of PTC in 1–4% of patients who underwent surgery because of suspected BrCC [5–8]. Age (>40 years) as well as the presence of enlarged lymph nodes seem to be a significant risk factor for malignancy instead of BrCC [6,7]. Because of the risk for cystic metastasis, patients over 40 years of age presenting with solitary cystic lesion are often subjected to extensive diagnostic work up before excision of the cyst.
Endotracheal Tube Electrode Neuromonitoring for Placement of Vagal Nerve Stimulation for Epilepsy: Intraoperative Stimulation Thresholds
Published in The Neurodiagnostic Journal, 2022
Gennadiy A. Katsevman, Darnell T. Josiah, Joseph E. LaNeve, Sanjay Bhatia
The ansa cervicalis is frequently located during surgeries in the anterior triangle of the neck and may be confused with the vagus nerve. The “ansa,” which in Latin refers to “handle of a cup,” refers to the superior root (descendens hypoglossi derived from the first cervical nerve, C1), the inferior root (descendens cervicalis derived from the ventral rami of C2 and C3), and the loop of their arrangement (Banneheka 2008b). The inferior root of the ansa may lie medial to the internal jugular vein (IJV) in 15% of cases and there can be communication between the ansa cervicalis and the vagus nerve, with the superior root of the ansa and the vagus running in a single connective tissue sheath; this may result in neck muscle contractions during the implantation of a vagal nerve stimulator (Banneheka 2008a; Gopalakrishnan et al. 2015). One study demonstrated that the ansa cervicalis of lateral type was observed in 34% of cases (i.e., when the inferior root runs anterior to the IJV to form the ansa on the anterior surface of the carotid sheath), medial type in 63% of cases (i.e., inferior root posterior to the IJV to form the ansa deep), and mixed type in 3% of cases (Banneheka 2008b). The vagus nerve, on the other hand, exits via the jugular foramen and runs down vertically in the carotid sheath between the internal carotid artery and the IJV and then between the IJV and common carotid artery (CCA) more distally. This, too, varies: a study determined that the vagus nerve was anterior to the CCA and IJV in 4% of cases, posterior to the CCA in 15% of cases, posterior to the IJV in 8% of cases, and posterior to but between the CCA and IJV in 73% of case (Dionigi et al. 2010). Given these variations, it is possible that the inferior root of the ansa cervicalis may be incorrectly identified as the cervical vagus trunk during the implantation of a VNS.