Step 4 Incising the Platysma Muscle

Retraction of the skin edges reveals the underlying platysma muscle, the fibers of which run superoinferiorly. Division of the fibers can be performed sharply, although a more controlled method is to dissect through the platysma muscle at one end of the skin incision with the tip of a hemostat or Metzenbaum scissor. After undermining the platysma muscle over the white superficial layer of deep cervical fascia, the tips of the instrument are pushed back through the platysma muscle at the other end of the incision. With the instrument deep to the platysma muscle, a scalpel is used to incise the muscle from one end of the skin incision to the other (Fig. 9-5). The anterior

Figure 9- 4 Incision through skin and subcutaneous tissue to the level of the platysma muscle. The incision parallels the lines of minimal tension in the cervical area. The incision does not parallel the inferior border of the mandible but courses inferiorly as it extends anteriorly

and posterior skin edges can be retracted sequentially to allow a greater length of platysma muscle division than the length of the skin incision.

The platysma muscle passively contracts once it is divided, exposing the underlying superficial layer of deep cervical fascia. The submandibular salivary gland can also be visualized through the fascia, which helps form its capsule.

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