Incisions for lateral neck dissection

Levels III and IV can usually be reached through a standard thyroidectomy incision or a slight extension of that traditional incision to the side of the neck dissection (A). For a more comprehensive neck dissection, the incision must be extended into the lateral neck, either along a skin crease (B) or with a superior "hockey-stick" extension either anterior or posterior to the sternocleidomastoid (C). Instead of using the superior extension of the main incision, some surgeons advocate using incision A and making a second counter incision high within the neck (also within a neck crease) in order to access level II adequately (D).