A litre saline bag is placed between the shoulders and the head supported on a rubber ring with the neck extended. If there is any evidence of cervical bone disease this is omitted. The neck area is infiltrated with local anaesthetic and adrenaline. One cms above the breastbone a 3 cms incision is made through skin and platysma.
Care is taken to avoid the cutaneous branches of the cervical nerve plexus.
The incision is so small that the anterior jugular veins are easily avoided and rarely damaged. The skin and platysmal flaps are raised down to the base of the sternal notch and up to the thyroid cartilage. The sternohyoid muscles are separated on both sides from the sternothyroid muscles until the descendens hypoglossi nerves and internal jugular veins are clearly seen. While separating these muscles a significant blood vessel is divided with diathermy at the upper end of the field. Rarely is there a need to divide the strap muscles.