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 to know if your ankle is broken? How is a broken ankle treated?

Fractures of the Ankle

How do ankle fractures occur? 

Ankle fractures are caused by a forceful and excessive twisting of the ankle, either in or out. The twist comes from stumbling, catching the foot in a crevice, or falling, in which the weight of the body is unevenly distributed. Many skiers suffer fractured ankles, and some of the best treatments have been evolved by surgeons practicing near ski slopes. The stress and strain factors in the ankle are so uniform that the pattern of the injury, dislocation and deformity is specific. Many varieties of ankle fractures are grouped together under the name of Pott's fracture.

What shall I do, Doctor? I'm at a gas station phone and my wife just fell down and twisted her ankle. 

If it is painful and she can't walk, it may be a fracture. Don't manipulate it, don't pull it. Just wrap a towel or pillow around it and take her to a hospital for an X ray. It is best if she does not walk. You can carry her in a chair.

How does an ankle sprain differ from a fracture? 

Most sprains are the consequence of forced ankle turn in which the foot is rocked in or turns under. The outer ligaments of the joints are strained, stretched, or even pulled off, but the major bone fragments remain intact.

What is special about ankle fractures? 

There is nothing "special" about these fractures. What is important is that injuries to this area often involve three separate bones: the ends of each of the long bones of the leg (tibia and fibula) and the joint part of the foot. These fractures frequently extend directly into the joint, raising the possibility of future arthritis in the injured area or a shift in the up and down plane of the ankle joint. This is a critical factor in determining recovery or disability. Along with displacement, dislocation or bone injury, the tendons are also frequently stretched or pulled off. The severity of ankle injuries varies considerably; some require a tight bandage while a very few may prove completely nonsalvageable and require amputation. The vast majority fall in between.

What determines whether you put a cast on or operate? 

If the displacements and broken parts can be put together and held by a cast, this is all that will be done. These injuries are referred to as stable fractures. On the other hand, with injuries and distortions that experience has indicated cannot be managed by closed (nonoperative) methods, realignment and stabilization are effected by an open (operative) method that ordinarily manipulates the bone and joints into position and mechanically maintains it by screws and plates.

The surgeon is concerned with restoring the weightbearing function of the foot. Whether the manipulation is external or by operation, the vast majority of these fractures are best manipulated under general anesthesia.

What kind of cast is put on and how do I manage with it? 

For lesser injuries, the physician applies a plaster boot, which extends from the toes to just below the knee. Frequently a walking heel is applied so the patient can get around with a crutch or cane. More complicated injuries require a cast from toes to groin and call for bed rest, then a wheelchair, and then up and about on crutches. Mobilization varies with the extent of injury and whether or not an open operation was required. Four weeks is about the minimum, but some cases need eight to twelve weeks to heal.

Will I have a scar after the operation? What kind of functional result can I reasonably expect? 

All incisions heal with a scar. Because a cast is also applied, these incisions usually heal beautifully as a thin hairline. Immobilization always improves the appearance of a scar. The result aimed for is good function and no pain. The final result cannot be truly evaluated until at least six months after the cast is removed. In severe injuries, where the whole area has been shattered, secondary reconstructive orthopedic procedures may be required, but these are necessary only in a minority of instances.

Do these screws and plates remain in permanently? 

Once the bone has healed, they have performed their function and remain as foreign bodies. In older people they are usually left in if they cause no symptoms. In younger people it is advantageous to remove excess hardware, but each case has to be evaluated individually.

Is My Ankle Sprained or Fractured?


If an operation is done, will I still need a cast? 

The operation serves only to clean up the area and to align the bones and the joint. A cast may still be required to maintain proper positioning.

What is internal fixation of fractures? How is it done and what is used? 

Internal fixation refers to the application of screws, nails, plates and bands to hold the bony parts in position. This is done by making a skin incision and separating the overlying tissues and muscles in such a manner as to reveal the fragmented bone. These bones are then set right. The metallic material is made of steel or vitallium. The procedure is done with great attention to sterility, for an infection in these circumstances can prove very troublesome.

What is the best time to operate? 

The surgery is best done before there is appreciable swelling, discoloration of the tissues or the formation of blisters. If any of these signs has already appeared, the operation should be deferred until the local reactions have subsided.

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