Authors of section

Authors

Ronald Lehman, Daniel Riew, Klaus Schnake

General Editor

Luiz Vialle

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Anterior access to C1–T2

1. Incision

The side of the incision, left or right mainly depends on the surgeons' preference.

With a left sided approach the course of the recurrent laryngeal nerve is more predictable.

Be using a right sided approach the same nerve can be visualized and protected.

anterior access to c1t2

The transverse incision is made at the level required. A transverse incision will give a better cosmetic outcome.

anterior access to c1t2

Injuries of the esophagus can be associated with fractures or occur as a complication of the approach.

In addition to the tracheo tube a nasogastric tube should be inserted to better identify and thus help prevent accidental injury to the esophagus.

These are serious and potentially lethal complications. Consultation with thoracic or ENT surgeons should be obtained.

anterior access to c1t2

2. Dissection

Platysma muscle is transected in line with the skin incision.

anterior access to c1t2

The deep cervical fascia is identified and divided along the anteromedial border of the sternocleidomastoid muscle.

anterior access to c1t2

A finger is then used for blunt dissection between the carotid sheath laterally and trachea and esophagus medially down to the prevertebral fascia.

Note: In case of carotid artery injury direct pressure should be applied and vascular surgery consultation requested urgently.

anterior access to c1t2

The prevertebral fascia is cut longitudinally allowing direct visualization of the vertebra and the longus colli muscle.

The level is verified with fluoroscopy.

anterior fixation

The longus coli muscle is mobilized and distractors are placed.

anterior access to c1t2

The recurrent laryngeal nerve is identified and protected.

anterior access to c1t2

3. Closure

The platysma muscle is sutured followed by a subcutaneous and skin closure.

anterior access to c1t2

A wound drain is inserted through a separate stab incision.

anterior access to c1t2