What is a radical neck dissection? when is it done?

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What is a radical neck dissection? The surgeon removes a block of tissue from the collarbone to the jaw and from the front to the back of the neck. The large muscle on the side of the neck that is used for rotating, flexing or extending the neck is also taken out, along with the major vein on the side of the neck. Sometimes, a less drastic operation, called a supraomohyoid neck dissection is done. This takes out only the lymph nodes, the tissue surrounding the nodes and a muscle at the front of the neck. Another technique, called a functional neck dissection, saves the muscles of the neck, taking out only the lymph nodes and tissues surrounding them.
What kind of incision is made with a radical neck dissection? The incision depends upon what the surgery is for. It can run from below the ear to the collarbone. Everything in the front of the neck on one side or on both sides may be removed. This may include the lymph nodes, blood vessels, nerves, and the salivary gland under the jawbone.

Cirrhosis of the liver but never drink. Can you live with cirrhosis of the liver?

Cirrhosis of the Liver

This disease of the liver can be the result of an antecedent virus infection (hepatitis), the toxic effects of alcohol, neglected gallstone obstruction, or severe malnutrition. When the liver is diseased in this way, it heals with thick scars, which replace some of the liver cells. These scars scramble the normal orderly structure of the liver, so the entering veins become congested and varicose. These internal varicose veins can be the source of alarming hemorrhage. The surgeon is called upon to handle the problems of this varicose vein bleeding. Cirrhosis from excessive consumption of alcohol has been recognized for centuries. Continued toxicity to the liver leads to complete failure of liver function, which is incompatible with survival.

In our own time, we are encountering an increasing incidence of cirrhosis in young people as a result of hepatitis transmitted by food, contaminated narcotic syringes or infected blood. These last all are preventable ways of contracting cirrhosis.

How did I get this liver trouble? 

I drank no more than many others in this same line of work. There are marked variations in individual sensitivity to alcohol. You may be constitutionally among those more easily affected. Then again it is always hard to remember how much one really drinks. The effect of four cocktails a day for fifteen years varies depending on also how well one eats along with this. Alcohol, a liver poison, is a liquid in which its chronic devotees believe their problems are soluble.

I never drank and was never sick in my life. How could I get cirrhosis of the liver? 

Some individuals get hepatitis without even knowing they've had it. In many' instances it can be so mild that it was like the flu. Nevertheless, that could have been the start.

Why is the abdomen swollen? 

The examination now demonstrates that there is a good deal of fluid in the abdominal cavity. The fluid can come from increased blood pressure in the liver or lymph blocks or malnutrition. It is a sign of serious liver disease.

How much fluid is there, and what do you plan to do about it? 

Several gallons of fluid may be present. One can be carrying about 25-40 pounds of weight that is due to this fluid. Various medications are given that will help the patient pass this fluid out through the kidneys. In other instances the fluid has to be removed by direct puncture of the abdomen.

What kind of bleeding is this? Where does it come from, and why is it so serious? 

The bleeding becomes very obvious and is quite frightening when it occurs. The patient vomits up brightred blood, and it is serious because the bleeding comes from abdominal veins that carry a high head of pressure, so high as to be three or four times the normal. Almost half the patients who go to the hospital with this type of bleeding, even for the first time, cannot be saved. Therefore, an individual who has survived one such episode is considered for corrective surgery.

Will it help if I stop drinking? 

That will help the liver from being further damaged, but at this point, so much damage has been done to the blood vessels that this alone will not always prevent further serious bleeding.

What kind of operation is this? 

The term used is "shunt surgery." The operation, and there are several choices available, makes new openings in the large tense abdominal veins to detour (hence "shunt") the blood away from the high pressure area into a low pressure zone. If this can be satisfactorily accomplished, the varicose veins which cause the bleeding will become less tense and will no longer tend to bleed.

Does this cure the liver condition? 

No. The liver disease is not improved. This operation serves only to prevent the serious problem of intestinal hemorrhage.

Does this operation work all the time? What are the risks? 

No operation works all the time. This operation works if the shunt can be successfully constructed and if it stays open. Some initially satisfactory operations subsequently fail because the opening that was made becomes closed by a clot. Then the bleeding can recur.

The operation is a major risk not only because it is delicate in itself but also because the diseased liver can create problems in healing and because the patient is especially susceptible to lung infections. Some patients develop mental aberrations and nervous system changes after this operation; these are the effects of excessive ammonia in the blood.

You're not offering a very encouraging opinion. In one sense that is true. In its advanced stage this is a serious liver disease. But if the operation is successful and the patient avoids alcohol and maintains a reasonable diet, the long term results for about 25 percent of the people are satisfactory. One can never tell which of four patients one will be.

When should the operation be done? 

First, it should not be done as an emergency while bleeding is going on, and, second, it cannot be successfully carried out on the individual whose liver tests indicate very severe damage that cannot be corrected by in hospital treatment. Such patients don't stand a decent chance; they are too poor risks. The operation should be done on the patient who has had a bleeding episode and whose liver is not so diseased as to interfere with the clotting mechanism, the healing of wounds, or the ability to avoid excessive bile in the blood.

Can you be sure that the bleeding is coming from these abnormal veins? 

We confirm this diagnosis by X rays of the area. Cirrhotics may also bleed from ulcers and inflammatory congestion of the stomach.

If I recover from the operation, will I require anything special? 

The avoidance of alcohol is paramount. The rest can be accomplished by diet with the addition of various vitamins and food cencentrates. A low protein diet may be required. If the operation goes well, the patient can return to his previous work, but he will require medical management at regular intervals, diagnostic blood tests, X rays, and a good deal of encouragement to keep on the sober path.

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