tailieunhanh - Marco Lucioni Practical Guide to Neck Dissection - part 5

chúng ta phải nhớ rằng, sau khi phlogosis lặp đi lặp lại, ví dụ như trong sialolithiasis, việc loại bỏ các tuyến có thể được đòi hỏi hơi nhiều nhiều hơn do những vết sẹo và chảy máu dữ dội hơn. Trong những trường hợp này, có một tăng nguy cơ tổn thương của dây thần kinh ngôn ngữ và hypoglossal. | Dissection 39 LINGUAL NERVE INTERMEDIATE TENDON OF DIGASTRIC MUSCLE Fig. Exercise 2 lingual artery Fig. Submental region sm submandibular gland 1 mylohyoid muscle 2 anterior belly of digastric muscle 3 suprahyoid white line 4 mandibular inferior margin 5 intermediate tendon of digastric muscle 6 hyoid bone 40 Submandibular-Submental Region Robbins Level I Take Home Messages 5 In submandibular surgery in benign pathology we must remember that after repeated phlogosis for example in sialolithiasis the removal of the gland may be more exacting due to scars and to more intense bleeding. In these cases there is an increased risk of lesion of the lingual and hypoglossal nerves. In the case of calculosis it is necessary to check that the section of Wharton s duct does not let any calculi and parenchyma pass into the distal stump. In submandibular surgery in malignant pathology the ablation includes the gland and the adipose and fascial tissue of the region when required exeresis may extend to the deep muscles to the lingual artery and if infiltrated by neoplasm to the hypoglossal nerve. The excision of this region is required for the rare primitive tumors of the gland or as a stage of laterocervical excisions Robbins level I especially for tumors of the oropharynx of the oral cavity and of the lower lip. It may also be a transit surgical stage for access to the parapharyngeal space after having dissected the digastric and stylienus muscles as an alternative to transmandibular access. Chapter 6 Laterocervical Region Supraclavicular Region -Robbins Level V 6 Core Messages Anatomic Layout The surgery of this region has a specific oncological significance for the treatment of lymphnodal metastases of tumors of the rhinopharynx oropharynx and of the posterior cutaneous tumors of the head and neck. It may also be considered for tumors of the larynx or of the hypopharynx if the presence of metastases at Robbins levels II or III has been ascertained. In the .