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.

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Obesity

A SURGICAL APPROACH 

It is easy to recognize when someone is obese. One need not look at age, weight and height tables. An obese patient has an abdominal skin fold ("tire") more than 1-1/4 inches in thickness. This is a suitable "clinical" guide and standard. A 150-pound man who becomes 20 percent overweight has doubled the amount of fat that he carries around. In this regard you can dig your own grave with your teeth. It has been called death on the expense account. This tissue has to be nourished, though it makes no advantageous contribution to the body economy. The excess fat is a parasite on its host. Most obese individuals have been through intermittent cycles of "starve or stuff."

I know I am too fat. How does that affect the actual surgery? 

The greater the bulk and girth, the more tissue to cut through to reach the involved area, making the operation more difficult and slightly bloodier. Oversize instruments, additional assistance and more anesthetic are required,along with a larger incision. There is increased difficulty in gaining access to the diseased area.

How does it affect the risk of the operation? 

The obese patient is more likely to have postoperative breathing and lung problems. Because of the excessive fat, which has poor resistance, the incision has an increased tendency to become infected. Therefore, these incisions may not heal properly, resulting in a postoperative hernia. In addition, obesity is frequently associated with a prediabetic or diabetic state, heart disease and high blood pressure.

How much weight should I lose before surgery? 

In an emergency there is no alternative to doing what is required immediately. If the operation is for a gallbladder or a hernia, something that can wait and be done electively, losing weight is important. Twenty percent heavier than normal is the desirable maximum, and it's worth taking the time to lose weight since it can offer big dividends in assuring the success of any surgical procedure.

How do I lose weight? Why am I overweight? I really don't eat more than other people. 

People can be overweight for a number of reasons. Some people truly metabolize differently and have no external control of the situation. However, in most instances, obesity comes from eating too much and a poor choice of diet. The problem had its origin earlier. Once excessive weight is put on, it doesn't take much to maintain it. You will be able to lose weight by controlling the amount and type of food that you eat.

Is it possible to remove this big apron of fat that hangs in front of my abdomen? It limits my activities, and it is difficult to keep the skin clean and free of moisture. If that were done, I am sure that I'd then be really stimulated to go on a strict diet. 

In general the treatment of obesity by nonsurgical methods is far more rewarding. Surgery is considered in rare instances where the abdominal apron is the last disturbing feature of an already successful general weight reduction that has been maintained. While the concept of removing this flabby area is simple, the operation can, in fact, be complicated and should be undertaken only when the apron of fat is the sole remaining problem.

Now that I've lost weight, can these remaining fatty areas about the middle of the thigh and buttock be removed? 

True, these fatty areas are ungraceful and have even been referred to as riding breeches obesity. Corrective surgery for this area should be considered only in very rare instances and under very exceptional circumstances. The cosmetic results and the scars frequently will not conform to the image that you may have of how you're going to look. This type of obesity is hard to remodel.

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I have heard that there is an operation that enables one to lose weight fairly rapidly. How does it work? 

There is a surgical procedure that achieves this purpose by rerouting the intestinal contents so that a part of the small intestine is excluded from performing its function. No intestine is removed. The procedure is reversible, and the normal bowel pathway can later be reconstituted. It may be viewed as a form of internal dieting because it limits the absorption of the oral intake.

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Since nothing else has really worked, should I have that operation on the small intestine? 

This is a very radical approach to the problem and is employed only in specially selected, severe cases when the patient has been 125 pounds or more overweight.

The operation results in undesirable changes in the liver and bone, and the majority of patients regain their weight subsequently. This operation is still largely in the investigative stage, and long term results are not yet available.

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