Step 2 Marking the Incision and Vasoconstriction

The skin is marked before injection of a vasoconstrictor. The incision for the retromandibular approach begins 0,5 cm below the lobe of the ear and continues inferiorly 3 to 3,5 cm (Fig. 10-4). It is placed just behind the posterior border of the mandible and may or may not extend below the level of the mandibular angle, depending on the amount of exposure needed.

Epinephrine (1:200.000) without a local anesthetic is useful, although routine local anesthetic with a vasoconstrictor may be injected subcutaneously to aid hemostasis at the time of incision. One should not inject local anesthetics deep to the platysma muscle because of the risk of rendering the facial nerve branches nonconductive, making electrical testing impossible.

Figure 10-4 Vertical incision just posterior to the mandible through skin and subcutaneous tissue to the depth of the platysma muscle.

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