ABSTRACT
Sternocleidomastoid Muscle Exposure of the sternocleidomastoid muscle is the key to successfully isolating both the jugular vein and carotid artery in the neck. Once the platysma has been sharply divided, a fatty layer is customarily encountered overlying the sternocleidomastoid edge. Dissection proceeds straight down along this fat until the edge of the muscle is clearly identified. There is no need to expose its entire belly, but rather the edge must be dissected out and pulled laterally. Ultimately this process exposes the jugular vein and leads to the carotid artery. At this point, a second blunt Weitlaner retractor is introduced vertically in the field to spread the incision in a caudal-cephalad direction and it also serves as a fulcrum over which the silk sutures can later be hung when the vessels are isolated. It is important to note that the first blunt Weitlaner retractor (holding the skin edges apart) may be deeply placed under both the sternocleidomastoid muscle and jugular vein on the lateral side but must be kept superficial on the medial side to avoid injury to the nerves in this region. It should be particularly noted that only blunt retractors are used in this area to avoid inadvertent injury to the major vessels of the neck.
