To preserve the marginal mandibular branch and prevent the corner of the mouth from drooping, the external facial artery and anterior facial vein are divided about a centimeter below the mandible and the upper cut ends tacked to the platysma of the upper flap forming a sling and lifting the nerve out of harm's way.
The insertions of the sternocleidomastoid muscle and the posterior belly of the omohyoid muscle are divided along the upper margin of the clavicle and the investing fascia is opened posteriorly to the trapezius and anteriorly to the midline. Supraclavicular nerves, underlying transverse cervical vessels and external jugular vein are divided and the underlying lymphatic-containing areolar tissue is swept upward. The bulb of the internal jugular vein and the brachial plexus come into view.
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