Reference no: EM133919513
Question
DIAGNOSIS: Right staphylococcal aureus cervical infection
PROCEDURE: Right superficial parotidectomy with facial nerve preservation and right neck dissection (modified radical of levels Ib, IIa, IIb, III, and V)
FINDINGS: Purulent scattered lymph nodes with multiple weeping lesions fistulizing from the nodes. Intramuscular lesions.
DESCRIPTION: The patient was brought to the OR where he underwent general endotracheal tube anesthesia. He was prepped and draped for normal face/head/neck surgery. We marked a typical parotid incision and modified it to include the 3 areas of weeping lesions. We then made the incision and raised typical flaps in a subplatysmal manner along the parotid fascia. The tissue was grossly inflamed. We identified the anterior belly of the sternocleidomastoid muscle. We cultured the fluid from 3 SCM lesions. We then excised them to remove all of the diseased tissue. We used the tragal pointer and the tympanomastoid suture line to identify the facial nerve. We confirmed its presence with a nerve stimulator and protected it. We performed a superficial parotidectomy. Attention was then turned to the cervical nodes. We performed level II, III, and V dissection. We then traced around the SCM and removed the visible nodes between the SCM and the jugular vein. We then continued to pull nodes out of level V after removing visible nodes in levels IIa, IIb, and III. We then turned to level Ib and took the nodes between the 2 bellies of the digastric muscle. We obtained meticulous hemostasis and closed the subplatysmal layer with 3-0 Vicryl sutures. We closed the deep layer with 4-0 Vicryl. We used 6-0 fast in the preauricular crease and finished with Benzoin and Steri-strips over as a final layer.
1. Does a superficial parotidectomy include some or all of the parotid gland? Which root operation is assigned?
2. In the Procedure it says "right neck dissection". What is this referring to? Describe the locations of levels Ib, IIa, IIb, III and V.