Cricopharyngeal Dysphagia
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Either a horizontal incision (usually left sided, level with the upper border of the cricoid), or a vertical incision (along the anterior border of the left sternomastoid muscle) is made. The authors favour a vertical incision for very large pouches. The deep cervical fascia is incised along the anterior border of the sternomastoid muscle, which is retracted laterally. The anterior belly of the omohyoid muscle is divided. The sternohyoid and sternothyroid are retracted towards the midline. The middle thyroid veins are then ligated and divided and this allows the ipsilateral lobe of the thyroid gland to be turned forwards. The contents of the carotid sheath are retracted laterally while the pharynx and larynx are gently rotated to the right. It is good practice to identify the left recurrent laryngeal nerve. It is in close proximity to the inferior thyroid artery, which may have to be ligated and divided. The recurrent laryngeal nerve enters the larynx just inferior to the cricothyroid joint. The dissection is then carried posteriorly along the anterior aspect of the prevertebral fascia so that the tracheoesophageal groove is identified. The pouch will lie immediately above this and can usually be palpated because of the packing within it. It should also be possible to feel the bougie within the oesophagus. This provides ‘a base’ on which dissection of the pouch can be carried out and it also helps prevent the excessive excision of oesophageal wall.
Transhiatal esophagectomy
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
An 8 cm oblique cervical incision parallel to the anterior border of the left sternocleidomastoid muscle is performed (see Figure 34.2). The platysma is incised and the sternocleidomastoid muscle, internal jugular vein, and carotid sheath are gently retracted laterally. The omohyoid muscle is transected. The larynx and trachea are retracted medially using the fingers of the assistant or a clamped small gauze only; no metal retractor is placed against the tracheoesophageal groove so that the risk of recurrent laryngeal nerve injury is minimized. The middle thyroid vein and inferior thyroid artery are identified and ligated. The dissection is carried out directly posteriorly on to the prevertebral fascia, which is followed bluntly with the index finger into the superior mediastinum. Then the plane between trachea and esophagus is developed further. The cervical esophagus is bluntly mobilized from adjacent tissues circumferentially, with particular care taken not to injure the posterior membranous part of the trachea, and encircled with a vessel loop. With upward traction on this vessel loop, blunt mobilization of the upper esophagus from the superior mediastinum is carried out, with the fingers kept at the esophagus at all times. A clamped small gauze can be helpful for onward blunt dissection. No formal cervical lymphadenectomy is carried out. The cervical esophagus is transected and a vein stripper is inserted and pushed downward until the tip can be released from the intra-abdominal cardia. A shoelace is fixed to the distal part of the transected cervical esophagus (see Figure 34.5a). A gallbladder clamp is placed on the distal margin of the cardia and is gently pulled downward to induce a slight tension on the specimen.
Head and neck
Aida Lai in Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Attachments of omohyoid muscle– origin: hyoid bone– insertion: scapula– nerve SS: ansa cervicalis C1–3– function: depress hyoid bone
Anterolateral approach for subaxial vertebral artery decompression in the treatment of rotational occlusion syndrome: results of a personal series and technical note
Published in Neurological Research, 2021
Sabino Luzzi, Cristian Gragnaniello, Alice Giotta Lucifero, Stefano Marasco, Yasmeen Elsawaf, Mattia Del Maestro, Samer K. Elbabaa, Renato Galzio
Platysma is freed from the skin layer, generally for 3 to 4 cm away from the site of the incision, in order to avoid any traction. It is then cut longitudinally, along the course of its fibers. The anterior border of the SMC is identified, with the carotid sheath coursing beneath it and containing the internal carotid artery (ICA), internal jugular vein (IJV) and vagus nerve. A pre-sternocleidomastoid precarotid exposure is carried out (Figure 1(d)). Omohyoid muscle is then isolated at a deeper level, encircled with a vessel loop and medialized (Figure 1(e)). Sternothyroid muscle, esophagus and trachea are left medially. The widening of the avascular plane between the SMC laterally and trachea and esophagus medially allows for easy identification of the pre-vertebral fascia. The fascial opening exposes the vertebral body and the medial border of the longus colli muscles. Moving laterally under microscopic vision leads to the identification of the lateral border of the ipsilateral longus colli. In a further lateral position, longus capitis and anterior scalene muscle are just lateral to the longus colli at C3-C4 and C4-C5, respectively.
Anatomical aspects of the selective infraspinatus muscle neurotization by spinal accessory nerve
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Radek Kaiser, Aneta Krajcová, Michal Makel, Gautham Ullas, Veronika Němcová
SSN arises from the upper trunk of the brachial plexus which is formed by the union of the ventral rami of the C5 and C6 and rarely from C4 root. The nerve passes across the posterior triangle of the neck parallel to the inferior belly of the omohyoid muscle and deep to the trapezius muscle. It then runs along the superior border of the scapula, passes through the suprascapular notch inferior to the superior transverse scapular ligament and enters the supraspinous fossa. It then passes beneath the supraspinatus, relatively fixed on the floor of the supraspinatus fossa, and curves around the lateral border of the spine of the scapula through the spinoglenoid notch to the infraspinous fossa. In 84%, there were no more than two motor branches to the supraspinatus muscle and in 48% the infraspinatus muscle had three or four motor branches of the same size [11]. The mean diameter of the suprascapular nerve at the suprascapular notch is 2.48 ± 0.6 mm [12].
The role of computed tomography and magnetic resonance imaging in surgical planning for thoracic outlet syndrome: the experience of a single third level reference center for peripheral nerve surgery
Published in Neurological Research, 2023
Alessandra Turrini, Carlo Maria De Masi, Carlo Sacco, Camilla Mencarani, Vanni Veronesi, Guido Staffa, Crescenzo Capone
An excision from the posterior border of the sternocleidomastoid muscle and along the proximal third of the clavicle is performed. A partial excision of the clavicular sternocleidomastoid insertion is made, and then subcutaneous tissue and platysma are dissected preserving the supraclavicular nerves. The omohyoid muscle is mobilized, the layer of the cervical fascia is dissected, and the scalene triangle muscles are identified. The scalenus anterior is completely dissected from the Lisfranc tubercle. Neurolysis of upper, middle and inferior trunks is performed.
Related Knowledge Centers
- Ansa Cervicalis
- Hyoid Bone
- Infrahyoid Muscles
- Sternocleidomastoid Muscle
- Suprascapular Notch
- Tendon
- Cervical Plexus
- Scapula
- Anatomical Terms of Muscle
- Superior Transverse Scapular Ligament