Description of Central Neck Dissection

Description of Central Neck Dissection

A central neck dissection includes removal of the prelaryngeal nodes superiorly and the pretracheal nodes inferiorly to the innominate artery. Also removed are the paratracheal lymph nodes inferiorly from the cricoid cartilage to the innominate artery on the right, and on the left to the axial plane where the innominate crosses the trachea. The recurrent laryngeal nerves are dissected with an atraumatic technique, minimizing manipulation and traction. The superior parathyroid gland is preserved in situ along with its primary blood supply from the superior branch of the inferior thyroid artery. The inferior parathyroid gland is usually reflected laterally along with its blood supply from the inferior thyroid artery. Parathyroid autotransplantation is performed if the glands are devascularized during dissection. Paratracheal tissue specimens are examined for parathyroid glands that may be salvaged and transplanted before being removed from the sterile field. Confirmation of parathyroid tissue with biopsy and frozen section before autotransplantation may reduce the risk of tumor transplantation in the presence of nodal metastasis. Paratracheal nodes are present posterior to the carotid artery on the right, as well as posterior to the inferior thyroid artery and recurrent laryngeal nerve on either side, which may require removal.