Đang chuẩn bị liên kết để tải về tài liệu:
Marco Lucioni Practical Guide to Neck Dissection - part 8

Điều đầu tiên để kiểm soát quá trình của dây thần kinh phế vị, đã quan sát thấy trong bóc tách các khu vực sternocleidomastoid, mà vượt qua phía trước động mạch và làm phát sinh các dây thần kinh tái phát ở gần biên giới kém của nó, các dây thần kinh tái phát lên phía sau. tàu về phía tiếp giáp với động mạch tuyến giáp kém | 76 Anterior Region Robbins Level VI - Inferior Part 8 Fig. 8.14 Esophagotracheal angle if hypopharynx cr cricoid cartilage tr trachea e esophagus t thyroid 1 cricothyroid muscle 2 cricopharyngeal muscle 3 Killian s mouth 4 recurrent nerve 5 tracheal vascular arches 6 parathyroid gland recent case histories say that the percentage of paralysis is considerably lower when the recurrent nerve is sought identified and preserved. 8.2.14 Isolation of the major arteries of the base of the neck starts from the bottom with exposure concentrating in particular on the common carotid artery in relation to the superior opening of the thorax. Following the common carotid caudad the subclavian artery can be reached from the right and isolated. The first thing to control is the course of the vagus nerve already observed in the dissection of the sternocleidomastoid region which passes anteriorly to the artery and gives rise to the recurrent nerve in proximity to its inferior border the recurrent nerve ascends posteriorly to the vessel toward the junction with the inferior thyroid artery where it was isolated beforehand. The arterial branches of the subclavian artery particularly the thyrocervical trunk lying just medially to the anterior scalene muscle are then isolated. The transverse cervical transverse scapular ascending cervical and inferior thyroid arteries all arise from this main branch of the subclavian and the latter two often have a common origin. The origin of the vertebral artery which ascends medially reemerging in the prever-tebral region is sought at roughly the same level on the posterosuperior border of the subclavian artery. Just after its origin it accompanies the vertebral vein which descends and passes anteriorly to the subclavian artery Fig.8.15 . The internal thoracic artery instead arises from the inferior margin of the subclavian. The subclavian artery then embeds itself passing posteriorly to the anterior scalene muscle and inferiorly to the brachial plexus