Netter’s Surgical Anatomy and Approaches (Netter Clinical Science)
The Atlas of Human Anatomy by Frank H. Netter, MD, has been the pinnacle of demonstrating the anatomy of the human body for generations of students. To those who would wish to perform or understand surgical procedures, however, there has been no direct link between the beautiful images created by Dr. Netter and the surgical procedures being performed. In Netter’s Surgical Anatomy and Approaches, we try to address a request by many Netter users to tie these anatomical diagrams to the procedures they perform.
This book presents the curriculum of basic and common general surgical procedures in chapters that portray the relevant anatomy for each procedure. In his very first edition, Dr. Netter stated that “anatomy of course does not change, but our understanding of anatomy and its clinical significance does.” Consequently, in some cases we have been able to pair the anatomy demonstrated in his illustrations with a modern intraoperative photograph or radiographic image. For some chapters, a new Netter-style illustration has been created to demonstrate a key anatomical point for an operative procedure or to show a key surgical perspective or orientation that is not captured in the original Netter images. The result is a volume that covers the most important and commonest areas in surgery, addressing common procedures in the head and neck, endocrine surgery, upper and lower gastrointestinal surgery, hepatobiliary surgery, surgery for hernias, vascular surgery, access and emergency procedures, breast and oncology surgery, and urology and gynecology.
A book like this would not be possible without the help of many people. Being fortunate to work at institutions such as University Hospitals Case Medical Center and Case Western Reserve University, I elected to enlist the support of my faculty colleagues in many different surgical specialties. It is only with the guidance and assistance of the editorial team of Jerry Goldstone, Jeffrey Hardacre, Julian Kim, Pierre Lavertu, Mark Malangoni, Jeffrey Marks, Christopher McHenry, Lee Ponsky, Michael Rosen, Christopher Siegel, and Sharon Stein, and the direction and guidance of the ever-patient Marybeth Thiel at Elsevier that this project has been completed.
On behalf of my co-editors and I, we hope you enjoy Netter’s Surgical Anatomy and Approaches.
Conor P. Delaney, MD, MCh, PhD
Neck dissection has been a standard method of removing at-risk or involved cancerous lymph nodes in the head and neck for more than 100 years. Crile first described the radical neck dissection in the early 1900s, but modifications by Bocca and others helped reduce the morbidity associated with lymph node removal, allowing for nerve and structure preservation when oncologically sound. This chapter discusses one of these modifications in detail, the selective or supraomohyoid neck dissection. A selective neck dissection, including levels I through III, is typically used for malignancies of the oral cavity in patients with N0 disease.
When a larger nodal burden is present, an extended (levels I-IV) selective neck dissection or a modified radical neck dissection (levels I-V) is indicated. Lesions in the oral cavity that approach or cross the midline require treatment of both sides of the neck
NECK ANATOMY FOR SURGICAL PLANNING
Understanding the regional lymphatic drainage pathways is critical when planning which type of neck dissection will be employed (Fig. 1-1). A supraomohyoid neck dissection is performed when treating patients who are at risk for micrometastasis in levels I, II, and III. The boundaries of levels I (submental and submandibular), II (upper jugular nodal chain), and III (midjugular nodal chain) are defined as follows: Level Ia: Bounded laterally by the medial aspects of the anterior belly of the digastric muscles, and ending medially at a line drawn from the mandible to the hyoid bone at the anatomic midline.
Level Ib: Bounded by the lateral aspect of the anterior belly of the digastric muscle, the medial aspect of the posterior belly of the digastric and stylohyoid muscles, and the inferior border of the mandibular body superiorly.
Level IIa: Bounded anteriorly and superiorly by the posterior belly of the digastric and stylohyoid muscles, posteriorly by the vertical plane defined by the spinal accessory nerve and sternocleidomastoid muscle (SCM), and inferiorly by the horizontal plane defined by the inferior border of the hyoid bone.
Level IIb: Bounded anteriorly by the jugular vein and inferiorly by the vertical plane defined by the spinal accessory nerve, posteriorly by the posterior border of the SCM, and superiorly by the skull base.
Level III: Bounded superiorly by the horizontal plane defined by the inferior border of the hyoid bone, inferiorly by the horizontal plane defined by the inferior border of the cricoid cartilage and/or the omohyoid muscle as it crosses the internal jugular vein, anteriorly by the lateral border of the sternohyoid muscle, and posteriorly by the posterior border of the SCM.
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