Leftsided incision 1 2 inches proximal to clavicle extending vertically from medial edge to manubrio

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MODIFIED ANTERIOR APPROACH TO CERVICOTHORACIC
JUNCTION

• Left-sided incision 1 2 inches proximal to
  clavicle extending vertically from medial edge
  to manubriosternal junction
• Platysma incised in line with skin incision/
  superficial veins cauterized
• Elevate manubrial and clavicular heads of SCM
  subperiosteally
• Strip remaining periosteum from medial clavicle
  and left manubrium
• Gigli saw to cut clavicle

2
MODIFIED ANTERIOR APPROACH TO CERVICOTHORACIC
JUNCTION

• Dissect interval between trachea/ esophagus and
  carotid sheath
• Retract left carotid sheath, subclavian vein and
  brachiocephalic vein inferolaterally to patients
  left
• Dissect prevertebral fascia

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STERNOCLEIDOMASTOID MUSCLE
Skin incision for anterior approach to the
cervicothoracic junction.
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STERNOCLEIDOMASTOID CLAVICULAR HEAD
STERNAL HEAD
OMOHYOID TRANSECTED
STRAP MUSCLES
EXTERNAL JUGULAR VEIN
PLATYSMA
The manubrial (sternal) and clavicular heads of
the sternocleidomastoid muscles have been
elevated (transected) to expose the clavicle.
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CAROTID ARTERY
VAGUS NERVE
INTERNAL JUGULAR VEIN
PHRENIC NERVE
LATERAL RETAINED CLAVICLE
LEFT RECURRENT LARYNGEAL NERVE
ESOPHAGUS
SUBCLAVIAN VEIN
MANUBRIAL ARTICULATION OF CLAVICLE
1st RIB
The medial third of the clavicle has been
resected.
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MIDDLE THYROID VEIN
CAROTID ARTERY
THYROID GLAND
C7
LONGUS COLLI
T1
T2
INTERNAL JUGULAR VEIN
BRACHIOCEPHALIC VEIN
Following vessel retraction, the spine is exposed.