ABSTRACT
The carotid sheath is opened using a microscope; ansa cervicalis can be preserved by proper dissection from the surrounding tissue. Lymph nodes should be removed by dissecting the surrounding connective tissue, taking care not to damage their vessels, which facilitates the deployment of the surgical field. It is quite important to identify the mandible, parotid gland, mastoid process, and sternocleidomastoid muscle when making a skin incision. In Asian patients, the bifurcation of carotid artery is usually higher than in Western people. Dissection of plaque can be started from a relatively healthy part of the CCA on the anterior side to correctly identify the plane to be dissected. A thin-bladed dissector is extremely useful for intimal dissection. The common facial vein often enters the internal jugular vein in the vicinity of the posterior belly of the digastric muscle, but care must be taken when dissecting it, as there is a great deal of variability among individuals.
