Posterior neck mass

Considerations

• • Patient positioning

    • Important to coordinate with Anesthesia regarding the appropriate position for the patient

    • Most posterior neck masses will require patient in prone positioning for adequate exposure

      • Work with OR nurse to find appropriate bumps, padding for patient 

  • General vs local with MAC anesthesia 

    • Again, both are options but the tumor and the patient's preference factor into the type of anesthesia 

    • Often the patient is choosing to have the procedure done under GA 

  • Drain or no drain

    • This is usually a game time decision, but be aware that you will likely need a passive or closed suction drain

    • Most large posterior neck masses will form seromas if not properly closed 

    • The suture technique is critical to seroma prevention

    • Drains are needed when dead space is present despite proper suture technique

Preparation

• • Optional: Ultrasound - to determine if mass is deep to muscle, and size of mass

  • Mark the incision site

    • A horizontal incision at least the length of the mass is ideal

  • Infiltrate 10-30 ml of 1% Lidocaine with 1:100,000 epinephrine 

    • Hydrodissect the place directly superficial to the mass and around the periphery 

  • Standard sterile prep and drape 

Procedure

Sample operative report

Findings:

- *** posterior neck *** cm fatty tumor in the subcutaneous plane

- Performed complete excisional biopsy via *** cm horizontal neck crease incision, layered closure to obliterate wound dead space, *** Penrose drain placement

Procedure in Detail:

PARC of procedure was explained to patient in ASU who agreed to proceed. Patient was brought into the room and laid on the OR table. Time out was performed with all OR staff.

GETA was applied. The *** cm incision was marked, oriented in an inferior horizontal neck crease. After cleaning the skin, local anesthesia was applied; 15 ml of 1% Lidocaine with 1:100,000 Epinephrine was injected. Sterile prep and drape completed.

Incision made with 15 blade scalpel through the dermis. Dissection in the immediate subcutaneous plane was completed over the mass. The dissection was continued around the mass, which appeared fatty with an *** indiscrete capsule, taking care to avoid surrounding normal subcutaneous fat and deep muscle.  The mass, which measured ~ *** cm in its widest dimension was removed in its entirety. Once removed, the mass was sent to Pathology as a permanent specimen. Irrigation completed. Hemostasis maintained with Bovie and Bipolar.

Wound closure with 3-0 Polysorb deep buried suture in the deep muscle and connected with deep dermal layer to approximate the dermis. A single 1/2 inch Penrose drain was placed exiting from the central incision, secured with 3-0 Prolene. The epidermis approximated with 5-0 Fast.  Skin cleansed and Fluff dressing applied, secured with Foam tape for light compression.  

Anesthesia discontinued; Patient awoken. Count correct. Patient moved to PACU in stable condition.

Post-op

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