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

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.

How are bleeding ulcers treated? How do you stop a bleeding ulcer?

How are bleeding ulcers treated?

An individual who is bleeding from an ulcer should be hospitalized on an emergency basis. He may require transfusions to replace the lost blood and a washout of the stomach to facilitate the possibility that the bleeding will stop by itself. Other nonoperative measures for the control of hemorrhage are also employed. If the bleeding is stopped by these treatment methods, a decision should be made about the need for surgery on the ulcer in the next symptom-free interval. If the bleeding appears to be continuing, an emergency operation may be necessary to remove the ulcer or to control its bleeding. In an unsupervised situation the patient can bleed to death just as if an artery in his wrist had been cut. Many surgeons believe that a senior patient who has already had a severe bleeding ulcer episode should not be permitted to go through a second episode without surgery. The fatalities from bleeding are higher than for any other ulcer complication. One in four patients operated on during an episode of massive bleeding may not survive.

Is there any way of preventing an ulcer from bleeding? 

Only in the sense that the ulcer disease in general should be treated to avoid this complication in particular. Aspirin and cortisone have been implicated as causes of stomach hemorrhage; both of these important drugs have to be used very cautiously in the ulcer patient.

Can these complications come on so suddenly that I have to limit my travels and activities to be near a big hospital? 

In a general way, that is a wise policy. But then your ulcer is ruling you instead of you controlling it. There are good hospitals and competent doctors almost everywhere. Unless you are going to some truly isolated area, the surgeon can give you the names of hospitals where you can expect to be treated properly. The disease is so common that it is known throughout the civilized world. It is not one of those rare diseases that only a small group is qualified to treat.


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