- The patient is placed in the supine position with a shoulder roll placed to provide neck extension.
- For this case, a tracheostomy was done to facilitate airway support for a major ablative head neck procedure.
- Frequently encountered is an occipital artery that "hooks" hypoglossal nerve, and pulls it inferiorly in the neck. If present, the artery will be ligated and divided.
- While the SAN travels posterior to the IJV most frequently, it can also travel anteriorly to it, and in the cases of a bifid jugular vein, through it.
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A.k.a. the submental triangle, Level 1a is between the two anterior bellies of the digastric muscles, and the hyoid bone.
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A.k.a. the submandibular triangle, Level 1b is between the anterior and posterior digastric muscles, and the mandible bone, where the submandibular gland sits.
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Level 2a is bordered by the spinal accessory nerve posteriorly, the posterior belly of digastric superiorly, and the hyoid bone inferiorly.
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Level 2b is bordered by the spinal accessory nerve anteriorly, the SCM posteriorly, and the posterior belly of digastric superiorly.
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Level 3 is bounded by the hyoid bone superiorly, cricoid cartilage inferiorly, the SCM laterally, and medially by the sternohyoid muscle.
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Level 4 is bounded by the cricoid cartilage superiorly, the clavicle inferiorly, the SCM laterally, and medially by the sternohyoid muscle.
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A.k.a. the posterior triangle, Level 5a is bounded by the SCM anteriorly, posteriorly by the anterior edge of the trapezius, superiorly by the mastoid process of the temporal bone, and inferiorly by the level of the cricoid.
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A.k.a. the posterior triangle, Level 5b is bounded by the SCM anteriorly, posteriorly by the anterior edge of the trapezius, superiorly by the level of the cricoid, and inferiorly by the clavicle.
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Level 6 is located medially inferior to level 1a, bounded superiorly by the hyoid bone, laterally by the sternohyoid muscles bilaterally / common carotid arteries, and inferiorly by the suprasternal notch / innominate artery.
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