Place appropriately prepared patient supine on operating table with a Mayfield headrest
Administer IV antibiotics
Turn head away from side of approach, usually towards right
Elevate table 30°
decreases venous bleeding
Prepare skin & drape patient, exposing neck from jaw to jugular notch
Landmarks
Hard palate – arch of atlas
C2-3 – lower border of mandible
C3 – hyoid
C4-5 – thyroid cartilage
C6 – cricoid cartilage & carotid tubercle
sternocleidomastoid
Incision
Transverse incision at level of fusion
From posterior border of SCM to midline
It is possible to access up to three levels via one transverse incision, but if wider access is required, less cosmetically pleasing incision can be made along anterior border of sternocleidomastoid
Internervous Plane
Platysma split
Facial nerve proximally
SCM
Accessory spinal nerve
Strap muscles
Segmental innervation C1-3
Superficial Dissection
Divide fascia over platysma in line with skin incision
Split fibres of platysma in their line using blunt dissection
Locate SCM (spinal accessory nerve)
& divide fascia along its anterior border, retract SCM laterally
