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 can you help a child with diabetes?

What can I do for my diabetic child?

There are many things you can do. You can help the child accept the disease and teach him or her how to take care of it. You can encourage diabetic children to achieve whatever they want to achieve in life despite diabetes. But there's one extremely important thing parents sometimes fail to do because they don't know it needs to be done that's to help them get rid of some of the terrible fears that diabetic children carry around inside and suffer over and don't talk about.

Dr. Robert Rood, a San Fernando Valley diabetologist who works with children and adolescents, told a story about a child at a summer camp where he was serving as physician. This girl was a model camper, full of fun and very popular.

Dr. Rood, in checking out her urine tests, discovered that her one shot of insulin a day wasn't doing the job, so he decided to divide her insulin into two doses morning and evening. This worked fine. Her blood sugar returned to normal. But she became very normal sullen, negative, picking fights. When he took her aside to talk she broke down and started crying. "I don't want to die," she said between sobs. "Die?" said Dr. Rood. "Why are you talking about dying?"

"I know my diabetes was bad before when I had to take one shot. Now it must be getting lots worse because I have to take two. I'm going to die. I know it." Dr. Rood reassured her, of course, and she became her good old self again, but he had learned something important. You never know what's going on in a child's head. You have to take the time to talk and explain. Be especially careful if there are any major changes in diabetes routines, lest the child interpret them as Dr. Rood's camper did.

Diabetic children also sometimes believe their diabetes is a punishment for "being bad." This gives them guilt feelings as well as fear that if they're ever "bad" again something even worse will happen.

And don't overlook the hidden fears and guilts of the nondiabetic children in the family. Younger children can get the idea that when they reach the age when the older child got it, they'll get diabetes, too. Each day to them becomes like the tick of a time bomb.

Guilt feelings arise when nondiabetic children have harbored some quite normal sibling rivalry evil thoughts, like "I wish Eddie would die," and lo, Eddie gets diabetes. They hold themselves responsible.

Parents must be aware of these dangers when the element of diabetes enters the family. Diabetes means there must be closer communication, more understanding, and more openness in the family. And that's all to the good.


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