Esophageal Surgery

Forward Head Posture Fix

Forward Head Posture Fix

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Like the various positions used in esophageal surgery, there are different incisions used depending on the location of the disease, the level of the anastomosis, and the surgeon's preference. Most of the time, a combination of two or more of the following incisions are used:

a) Upper midline laparotomy

- As described in the previous section on the abdomen

- Can be combined with a transverse laparotomy for better exposure b) Thoracotomy

- Anterolateral: skin incision usually in the fourth or fifth intercostal space

- Posterolateral: skin incision in the seventh intercostal space at the angle of the scapula (A-1). A paravertebral or anterior extension is possible

- The intercostal muscle is freed from the upper border of the rib (avoids damaging the intercostal nerve and blood vessels, which lie behind the inferior border of the rib) (A-2)

- The parietal pleura is opened with scissors, and the ribs are separated with a retractor c) Cervical incision (B-1)

- Incision along the anterior border of the sternocleidomastoid muscle (B-2)

- Division of the platysma in the direction of the incision

- The omohyoid muscle (B-3) and, if necessary, the inferior thyroid artery and/or middle thyroid vein are divided to provide clear exposure

- The sternocleidomastoid muscle and carotid sheath and its contents are retracted laterally, and the trachea and larynx are retracted medially

- No retractor should be placed against the recurrent laryngeal nerve in the tracheoesophageal groove during the entire cervical phase of the procedure

- For better exposure, the medial part of the sternocleidomastoid muscle can be cut inferiorly close to the clavicle bone

- Identification of the flat, decompressed esophagus can be helped by inserting a large tube into the esophagus by the anesthesiologist

- In patients with a "bull neck" habitus or with osteoarthritis preventing extension of the neck, a partial upper sternal split can provide the prerequisite access to the high retrosternal esophagus

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