Download Atlas of Advanced Operative Surgery by Vijay P. Khatri MD FACS PDF

By Vijay P. Khatri MD FACS

Strengthen your surgical services with Atlas of complicated Operative surgical procedure! This new source selections up the place different surgical references go away off, supplying hugely visible, step by step information on greater than a hundred complicated and complicated systems in either common and subspecialty parts.

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The fascia is then dissected off the anterior belly of the digastric muscle and the specimen is retracted posteriorly, removing the fibrous fatty tissue containing lymph nodes lateral to the mylohyoid muscle. When the dissection reaches the posterior border of the mylohyoid, this is retracted anteriorly, exposing the lingual nerve and the submandibular gland duct, which are divided. The hypoglossal nerve and the veins that usually accompany the nerve are left undisturbed as the dissection continues in a posterior direction.

Most surgeons do not prefer this, because follow-up evaluation of the parotid bed might be made quite difficult. u The ramus mandibularis is an extremely sensitive nerve, and surgery may lead to temporary weakness of the lip. This should improve in 4 to 6 weeks. u Rarely, the patient may have a salivary leak through the wound, which may require multiple aspirations and careful observation. u Delayed complications include Frey syndrome. Even though there is no definite or specific explanation of this syndrome, it generally occurs 6 to 9 months after surgery and is thought to be related to regeneration of the nerves and aberrant nerve supply from the facial nerve to the parasympathetic nerve supply to the sweat glands in the region of the parotidectomy.

U 11 12 Section I • Head and Neck II. OPERATIVE TECHNIQUE Position The position is supine in the operating room with a shoulder bolster and a donut to hold the head. The head is turned away from the surgical site, approximately 45 degrees to the midline. This will help expose the posterior region of the neck. u The neck is prepared as usual with exposure of the ear, which is quite helpful in neck dissection as an anatomical landmark. u The endotracheal tube is well secured on the other side of the surgical procedure, and the table is positioned in a 15- to 20-degree reverse Trendelenburg position to diminish venous congestion and blood loss.

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