Surgery,

Rare types of hernia

Timings of surgery in congenital conditions

THORACIC TRAUMA❗️

Burns

Urethral Trauma

1.First step to make neck node dissection easy is to study the LN levels - use the below attached image or try to mark the LN on oneself

2. Let's divide into 2 classification s

a)Therapeutic - when LN clinically palpable or detected radiologically

Prophylactic neck dissection - dissection done even when LN not palpable or detected in radiology

Eg.medullary carcinoma thyroid 

b)Radical- level 1 to 5 +

             Spinal accessory N , IJV ,Sternocleidomastoid

(S I Ster) +

               + submandibular gland & tail of parotid gland 

CRILES method CRYles (patient crys due to functions lost) shoulder joint dysfunction was maximum in these patient hence surgeon came with idea of preserving Spinal accessory nerve( trapezius) if the nerve was not directly involved..hence modified radical neck dissection 

Now a days radical neck dissection is rarely performed 

modified radical neck dissection 

mrnd 1 - 1 structure preseved .Spinal accessory nerve(S)

mrnd 2 - 2 structure preserved.spinal accessory nerve +IJV(S I) - reduce shoulder dysfunction and facial edema

mrnd 3 - 3 structure preseved. Spinal accessory nerve, IJV,Sternocleidomastoid (S I Ster)

Aka functional neck dissection/Bocca as maximum function is preserved

selective neck dissection ( not all LN removed like in radical or mrnd where lvl 1 to 5 is removed) only selected LN removed

supraomohyoid LN 1,2,3( LN above sup.belly of omohyoid)

extended supra omohyoid LN 1,2,3 4

lateral  LN 2,3,4 

posterolateral LN 2,3,4,5( lateral + posterior traingle LN)

central  LN 6

commando operation- combined mandibular resection + neck dissection 

Hope this helps!!

Happy learning 😃

by - Dr Aparna