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.

How do you know if your wrist is fractured? How is a fractured wrist treated?

Wrist Fractures

I felt myself slipping and stretched my arm out for support. Now my wrist is swollen and painful. Is it broken? 

Symptoms of pain, swelling and deformity are characteristic of a fracture. However, this impression should always be supported by an X ray. This X ray shows a fracture of the lower end of the forearm, an injury so common that it is called a Colles fracture after one of the early bonesetters.

What should be done about a wrist fracture and when? 

This fracture is best treated as soon after the injury as reasonable and certainly before there is marked swelling and muscle spasm. Under ordinary circumstances, the patient need not stay in the hospital after the bone has been manipulated back into position and a cast applied. The entire procedure can be painlessly accomplished by injecting a local anesthetic into the fracture site.

Why do you take another X ray after you set the wrist fracture? How long will this cast be on? What does the cast really accomplish? 

A second X ray is taken to discern whether the manipulation has restored the bones to a satisfactory position. With a wrist fracture the aim is to correct the backward angulation of the joint, and the X ray will indicate to what degree this has been accomplished.

The cast will be on about four weeks. The cast prevents the part from moving, which could result in impaired healing, and maintains the position achieved by corrective manipulation.

I'm curious. How do you actually bring it together? 

This varies for each particular fracture and sometimes from patient to patient. The general procedure is to exert pull and counterpull on the wrist and arm to counteract the muscle spasm. The fragments are manipulated apart by exaggerating the deformity and are then brought into proper alignment and locked (impacted) into position by pulling and rocking motions. The relation between certain palpable bony landmarks is a good indicator of how well the manipulation has been accomplished.

What do I do while the cast is on? Can I get wet? What if it gets dirty? Will it have to be changed?

Keep moving your fingers. You can play the piano with this cast on. Keep your elbow actively bending and stretching. These uninjured muscles must be kept active to prepare them for resumption of function when the cast is removed.

If the cast gets wet, it weakens. Keep it as dry as possible by wrapping it in a protective plastic material while showering. It is not advisable to drive, since control of the wheel is less than perfect. Dirt on the cast makes no difference; youngsters usually have their friends cover it with autographs. In this kind of fracture the cast is changed only if it becomes so loose that the fracture is no longer sufficiently immobilized.

How will it be after the cast is removed? 

The forearm will be stiff for a short while, and the skin will appear somewhat shiny. Ordinarily these symptoms disappear and most people can carry on their usual activities. A deformity may persist if the joint angle is abnormal. The need for subsequent corrective procedures is rare but depends on the functional requirement.

Distal Radius Fractures

Why should I see you 12-24 hours after the cast has been put on? 

To be sure that the cast is not too tight and that the swelling about the site of injury is not affecting circulation. The cast has been cut out so that your fingers and elbow can move freely. The doctor should see whether the fingers have become swollen, blue, pale, painful or cold. If all is satisfactory, it will only take a minute to know it, and, if not, the cast can be loosened.

Why do you ask in such detail about how the injury was sustained? 

Specific injuries are associated with specific types of accidents. For example, falling on an outstretched arm usually fractures the wrist, but the fracture may occur near the elbow joint or the upper or lower end of the arm or even the collarbone. All these areas should be examined after this kind of fall.

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