Hellow guys, Welcome to my website, and you are watching Cervical Nodal Metastases Invading the Carotid Artery - Head & Neck Cancer Surgery. and this vIdeo is uploaded by Cancer Surgery Masterclass at 2021-07-13T18:00:35-07:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | Cervical Nodal Metastases Invading the Carotid Artery - Head & Neck Cancer Surgery |
| Video Uploader | Video From Cancer Surgery Masterclass |
| Upload Date | This Video Uploaded At 14-07-2021 01:00:35 |
| Video Discription | Hello, we warmly welcome all of you to our channel, Cancer Surgery Masterclass! Today we will look at an interesting patient who had a recurrent right sided squamous cell carcinoma of the tongue with cervical nodal metastases. The patient was a 62-year-old individual who had a small early invasive lesion two years ago which was treated by wide local excision at an oral surgical unit. It is our policy to perform a selective nodal dissection for even small tongue cancers of squamous origin considering the fact that up to 40% of tongue cancers in our country tend to have occult metastases to the cervical nodes. Sadly, however no such treatment was offered during the initial surgery. The patient presented to us with a recurrence at the same site & a fixed level II nodal mass. CT reveled involvement of the internal Jugular vein & compression on the carotid bifurcation by the mass. A wide local excision & a radical block dissection was planned. A curved hockey-stick incision was carried out & the flaps were raised in the subplatysmal plane. The sternocleidomastoid muscle was divided. A portion of the inferior belly of the omohyoid was excised to gain complete access to the carotid sheath. The IJV failed to expand which showed obstruction in the cephalic direction. The deep fascia posterior to IJV was incised & fat containing Level IV & level III nodes was removed from the surface of the scalenus anterior & medius. When the nodes are cleared off, the right phrenic nerve can be seen lying on the scalenus anterior. Care must be taken not to damage it. The IJV was separated & the two ends secured. The divided upper segment of the IJV together with the sternomastoid muscle & fat containing the nodes were separated from the remaining structures of the carotid sheath in upward direction. Usually, it is very easy to separate the IJV & the carotid artery by blunt finger dissection. Failure to achieve this, can occur when the patient had received radiotherapy previously to the cervical region or the presence of tumor between the IJV & the carotid artery. Close to the bifurcation it was evident that the tumor has at least infiltrated the adventitia of the carotid artery. We therefore carried out debulking & avoided performing heroic attempts to achieve complete macroscopic removal of the tumor, since such an attempt might lead to catastrophic hemorrhage & a possible massive cerebral infarction. Around 95% of macroscopic tumor excision done. Since it was difficult to trace the IJV through the nodal mass, the distal IJV was reached by separating the sternomastoid muscle & fat superior to the mass. Level IIA & I nodal excision was carried out which included submandibular sialoadenectomy. Wide local excision of the tongue lesion was done using monopolar diathermy. The defect was repaired partially by approximating sutures at each end. A radial forearm free flap would have been ideal to close the defect but tumor invasion of the vasculature of the neck prevented such a possibility. This channel is dedicated to everyone who is interested in the field of Oncological surgery & is conducted by Dr. Anuruddha Thewarapperuma MBBS MS, a Consultant Cancer Surgeon from Sri Lanka. This includes a series of video classes & lectures on operative surgery with illustrations, valuable tips and advice. Please feel free to comment, give suggestions & ask questions in the comment section below. We hope this channel will be thought provoking and inspiring to all the surgeons, medical students, aspiring doctors, nurses and anyone in the surgical community who is interested in Cancer Surgery. We wish you all the best! Thank you! Contact us cancersurgerymasterclass@gmail.com |
| Category | Education |
| Tags | Cancer surgery | Oncology | Oncological surgery | Class | Lectures | surgery lectures | video class | surgeons | doctors | nurses | Nucleus Medical Media | Medstar Health | Operation | Breast cancer | Thyroid cancer | Lung cancer | Esophageal cancer | Head & neck cancer | Gastric cancer | Colon cancer | Liver cancer | Pancreatic cancer | Uterine cancer | Ovarian cancer | Prostate cancer | Bowel cancer | Bone cancer | Skin cancer | Armando Hasudungan | John Gilmore M.D. | Dr. Najeeb Lectures | metastasis |
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