title: Transection of Omohyoid Muscle as an Aid During Vagus Nerve Stimulator Implantation.
abstract: BACKGROUND
  Exposure of the carotid sheath during vagus nerve stimulator (VNS) implantation is usually straightforward but can be difficult for patients with a large body habitus. In addition, the exposure must be done with care if the surgeon wants to keep the vagus nerve in situ without using retractors that might impair access.
  
  
  OBJECTIVE
  We describe the use of the omohyoid muscle as a landmark for the jugular vein and report how transection of the omohyoid can facilitate rapid and wide exposure of the carotid sheath.
  
  
  METHODS
  We review the records of 59 consecutive patients undergoing VNS implantation from 2009-2015 and describe our technique incorporating omohyoid transection. We also summarize complications such as postoperative hoarseness, cough, dysphagia, or wound issues.
  
  
  RESULTS
  Forty-two of the 59 patients (29 adults and 13 children) underwent omohyoid transection during implantation. In all cases, the carotid sheath and jugular vein were immediately visible after transection. One patient developed permanent hoarseness and coughing due to left vocal cord paresis, requiring further surgery. This result was most likely due to manipulation of the vagus nerve rather than division of the omohyoid muscle.
  
  
  CONCLUSIONS
  Omohyoid transection provides excellent exposure of the carotid sheath during VNS implantation.
authors.affiliation: Department of Neurosurgery, Augusta University, Augusta, Georgia, USA. Electronic address: jyowtak@augusta.edu.
authors.forename: June
authors.initials: J
authors.lastname: Yowtak
authors.affiliation: Department of Neurosurgery, Augusta University, Augusta, Georgia, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Jenkins
authors.affiliation: Department of Neurosurgery, Augusta University, Augusta, Georgia, USA.
authors.forename: Cole
authors.initials: C
authors.lastname: Giller
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D008297:Male; D009334:Neck Muscles / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000601:surgery*
keywords: Epilepsy; Nerve; Omohyoid; Stimulation; Vagus