Professional Documents
Culture Documents
Operative Surgery
Operative Surgery
Operative Surgery
2,Dorsal slit
4,Ligatting frenular A
• Identification of parathyroid
• Yellowish pink (peanut butter appearance) if devascularised become greyish
• Sinks in NS
• Position
• Sup parathgyroid : middle of superior & inferior throid A
• Inferior parathyroid : sup parathyroid & sup mediastinum
• Incision:
• Tranverse curved incision 3-4cm at the level of 2nd tracheal ring.(horizontal)
• Vertical in emergency
• Dissection: Skin , subcutaneous tissue and deep fascia are incised.Isthmus of thyroid is separated.
• Procedure:
• A transversed curved cut is made at the level of 2nd tracheal ring, its edge is held by Allis forceps
and a small cuff of cartilage is removed. Cricoid hook can be used to stabilise the trachea (found
more usefull in children).
• Ligate anterr jugular vein ,isthmus of thyroid ,thyroidima
• A suitable sized tracheostomy is introduced within.
• The cuff of tracheostomy tube is inflated by using 2-5ml of air and is held in place by passing a
tape around the neck.
• Confirm the tube in the trachea not in the subcutaneous plane.
• Confirm air entry into both lungs.
• Post op complication
• wound infection
• Air leakage
• Improper air entry
• cricoid stenosis
• bassini’s repair
• The conjoined muscle of the transversus abdominis and the internal oblique
muscles is sutured to the inguinal ligament by 3-5 interrupted sutures (non
absorbable suture)
• Drawbacks
• Undue tension to relieve it tanners slide operation (transverse incision on rectus sheath)
• Recurrence due to approximation of muscle to a ligament & thick distant bites
• A palpable varicocele.
• Symptomatic
• Pain
• Sub fertility.
• Jobs like army
• Anaesthesia : GA
• Position
• Head is extended by elevating the shoulders
• Head rotated to the contralateral side
Lazy S Incision
From the level of tragus of the
ear ( along the crease), winding
around the lobule towards the
mastoid and curving down
anteriorly 2 inches along the .
anterior border of SCM to upper
Cervical crease.
2. Just deep to the cartilaginous pointer is a bony landmark formed by the curve of the bony
external meatus & its abutment with the mastoid process. This forms a palpable groove
(Tympanomastoid Suture) leading directly to the stylomastoid foramen.
4. Styloid process itself can be palpated superficial to the stylomastoid foramen & just superior
to it. Nerve is always lateral to this plane & passes obliquely across the styloid process.
5. Retrograde Dissection
drain
TONY 2010 MBBS 96
Conservative parotidectomy
• Systemic therapy:
a. Chemotherapy
b. Hormonal therapy
c. Monoclonal antibodies.
• Metastatic workup.
• Pre-anesthetic evaluation.
• Position
• The patient is placed in supine position with the arm
abducted < 90 degree.
• Incision:
• Horizontal elliptical incision is marked so as to include the entire
areolar complex.
• Should be 1-2cm away from the tumor margins.
• Skin sparing incision- if breast reconstruction is planned
• Two skin edges should be of equivalent length
• 3 modifications:
a. Patey’s
b. Scanlon’s.
c. Auchincloss.
2. Scanlon’s procedure:
• P.minor is retracted to expose level III nodes and dissected out.
3. Auchincloss procedure:
• Level I and II lymph nodes are cleared, level III nodes are left
behind.
• Incision:
• Oblique elliptical incision angled towards axilla.
• Should include the entire areolar complex and previous scars, if present.
• Should be 1-2cm away from the tumor margins.
• Two skin edges should be of equivalent length
• Extent of dissection:
• Superiorly till clavicle,
• Breast tissue, axillary lymph nodes and pectoral muscles are removed.
• Disadvantages:
• Bad scars and unacceptable deformity.
– Local recurrence is
acceptable, 0-3%.
• Quadrantectomy.
• Method: • Indications:
• Wide local • Stage 0 (CIS), Stage I,
excision/Lumpectomy or Stage IIa breast
Quadrantectomy +
carcinoma.
axillary lymph node
• Single lesion.
clearance +
radiotherapy. • Clinically downstaged
LABC (controversial)
• Obsolete.
• Multicentricity or multifocality
palliative.
• Usually done for lesion in the upper outer and inner lower
quadrants.
Removes Preserves
• Removing all lymphatic tissues in
regions I - V • Posterior auricular
• Spinal Acessory Nerve • Suboccipital
• Internal Jugular vein • Retropharyngeal
• Periparotid
• Sternocleidomastoid muscle
• Perifacial
• Submandibular Salivary gland • Paratracheal nodes
• Tail of parotid
• Omohyoid muscle
2. Large metastatic tumor mass or multiple matted in upper part of the neck
• Tumor should not be dissected to preserve Structures
Contraindications
• 1. untreatable primary lesion (fixed)
• 2. Involvement of internal / common carotid artery
• 3. Presence of distant metastasis.
• 4. Poor anaesthetic risk patient.
• Excision of all lymph nodes removed with RND (Nodal groups I-V)
• with preservation of one or more non-lymphatic structures, SAN, SCM and/or
IJV
• Subtype I: Preserve SAN
• Subtype II: Preserve SAN & IJV
• Subtype III: preserve SAN, IJV and SCM
• Known as Functional neck dissection (Bocca)
Indications
– Clinically obvious lymph node metastases (XI preserved)
– SAN not involved by tumor
–Intraoperative decision
Preserve SAN
&
IJV
• Definition
• – Any previous dissection which includes removal of one or more
additional lymph node groups and/or non-lymphatic structures.
• – Usually performed with N+ necks in MRND or RND when
metastases invade structures usually preserved
3 point
intersectionflap
necrosis
McFee Incision
H Incision
J Incision
COMPLICATIONS
• Air embolus
• Pneumothorax
• Chyle leak & Chylus fistula
• Wry Neck (Torticollis Coli)
• Shoulder dysfunction
• Cerebral oedema
Incision and drainage of abscess
• Surgical procedure:
• Elliptical incision around the summit of the swelling encircling the punctum.
• Layers opened:
• Incision should be superficial. Care should be taken not to cut open the cyst wall.
• The principle is to completely excise the cyst with its wall and the overlying punctum and a bit of
the surrounding skin around the punctum.
• Dissection
• A plane is created between the skin and the cyst, carefully, preventing opening of the cyst wall.
• An Allis forceps may be applied to the punctum and the elliptical skin to get a traction. Flaps need
to be raised gradually on either sides of the incision and then deliver the cyst in toto.(huh?)
• If the cyst wall opens up, the sebum is removed completely and an effort to remove all the cyst
wall in piece meal is made.
• Closure: Single layer closure of the skin. suture removed after 7-10 days.