Việc thăm dò phẫu thuật của khu vực này sẽ quan tâm chủ yếu là các trục jugulocarotid và adnexa của nó. Đây là khu vực mà các bác sĩ phẫu thuật oncological đầu và cổ khám phá thường xuyên nhất. | Chapter 7 Laterocervical Region Sternocleidomastoid or Carotid Region - Robbins Levels II III and IV 7 Core Messages The surgery of this region has a specific oncological significance for the treatment of lymph node metastases of tumors of the upper respiratory and digestive tracts. The surgical exploration of this region will concern mainly the jug-ulocarotid axis and its adnexa. It is the area that the oncological surgeon of the head and neck explores most frequently. Anatomic Layout The sternocleidomastoid region as defined by anatomists corresponds approximately to Robbins levels II III and IV. It comprises roughly the sternocleidomastoid muscle and all that lies below it considering the head in a normal position. Robbins s classification 2002 2 gives its precise limits which are the base of the skull and the stylohyoid muscle at the top the clavicle at the bottom the posterior margin of the sternocleidomastoid muscle at the side and anteriorly the lateral edge of the sternocleidomastoid muscle. The three levels are divided in the cranio caudal direction by the inferior edge of the hyoid bone and the inferior edge of the cricoid cartilage. The significant lymph node groups are above all those of level II and III which represent the principal stations of lymphatic drainage of the neck. Significant anatomical structures common trunk of the spinal accessory nerve cervical plexus carotid arteries internal jugular vein vagus nerve hypoglossal nerve thyrolinguofacial trunk phrenic nerve subclavian artery thoracic duct. Landmarks transverse process of the atlas stylohyoid muscle omohyoid muscle greater cornu of the hyoid bone carotid tubercle. Dissection We begin the dissection of this region from the most cranial part. We identify the deep musculofascial plane which is formed lateromedially by the splenius capitis levator scapulae and scalene muscles. After having applied traction medially on the sternocleidomastoid muscle with a Farabeuf we seek by .
