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The term “difficult neck” refers to clinical and surgical scenarios where access, visualization, or intervention in the neck region is challenging due to anatomical or pathological factors. This is particularly relevant in head and neck surgery, thyroidectomy, neck dissection, or parathyroid surgery. According to the image (Box 18.10), a difficult neck includes the following factors: 🔶 Features of a Difficult Neck: 1. Difficult to assess – Due to altered anatomy, prior surgery, or radiation. 2. Short, stocky neck – Limits surgical exposure and anatomical orientation. 3. Retropharyngeal nodes – Hard-to-access lymph nodes situated deep in the neck. 4. Recurrent disease – Previous surgeries or recurrence distorts normal tissue planes. 5. Involvement of vital structures – Tumor or inflammation encasing or adjacent to carotid artery, jugular vein, vagus nerve, etc. ⸻ 💡 Clinical Importance: • Surgeons need to plan more carefully (e.g., pre-op imaging, skilled assistance). • Increased risk of complications. • May require alternative or staged approaches.