Transection of the omohyoid muscle as an aid during vagal nerve stimulator implantation.

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Transection of the omohyoid muscle as an aid during vagal nerve stimulator implantation.

World Neurosurg. 2016 Dec 05;:

Authors: Yowtak J, Jenkins P, Giller C

Abstract
BACKGROUND: Exposure of the carotid sheath during VNS implantation is usually straightforward, but can be difficult for patients with a large body habitus. In addition, the exposure must be done with care if the surgeon wishes to keep the vagus nerve in situ without using retractors that might impair access.
OBJECTIVE: To describe the use of the omohyoid muscle as a landmark for the jugular vein, and to report how transection of the omohyoid can facilitate a rapid and wide exposure of the carotid sheath.
METHODS: We review the records of 59 consecutive patients undergoing VNS implantation from 2009 to 2015 and describe our technique incorporating omohyoid transection. We also summarize complications such as postoperative hoarseness, cough, dysphagia or wound issues.
RESULTS: Forty-two of the 59 patients (29 adults and 13 children) underwent omohyoid transection during implantation. In all cases, the carotid sheath and the jugular vein were immediately visible after transection. One patient developed permanent hoarseness and coughing due to left vocal cord paresis requiring further surgery. This result was most likely due to manipulation of the vagus nerve rather than division of the omohyoid muscle.
CONCLUSION: Omohyoid transection provides excellent exposure of the carotid sheath during VNS implantation.

PMID: 27931947 [PubMed - as supplied by publisher]

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