ABSTRACT
Once the platysma has been divided, it is useful to prepare the incision for a high exposure in nearly every case so that a difficult ICA repair will not necessitate returning to the superficial tissues for exposure during a critical time in the procedure. I prefer to come down the subcutaneous tissues with the electrocautery set on coagulating current; I find that this dissects down the medial sternocleidomastoid edge to the jugular vein quite nicely and hemostatically. As this is done in the cephalad end of the incision, the parotid gland will be encountered in the soft gritty tissues. I prefer to scoop behind the gland with the cautery tip, freeing it to be held forward by the hinged modified Richards retractor. This gives a nice exposure of the underlying high complex, including the jugular vein, hypoglossal nerve, and ICA as well as the digastric muscle. If the gland is transected, too much of it remains posteriorly, which obscures the view, and the risk of sialorrhea or facial nerve injury is increased.
