Anatomical Variations of the Cervical Plexus

Objective: This study was conducted to identify anatomical variations of the spinal accessory nerve (SAN) in the upper neck, the landmark of the anterior and inferior border of level IIb, and to evaluate the nerve's effect on the border and the number of lymph nodes (LNs) in level IIb. Study Design and Setting: Case series with planned data collection. Subjects and Methods: A total of 181 neck dissections (NDs) were prospectively enrolled in this study. The relation between the SAN and adjacent structures (internal jugular vein [IJV], sternocleidomastoid muscle [SCM], cervical plexus) and the number of LNs in level IIb was investigated. Results: The SAN crossed the IJV ventrally in 72 cases (39.8%) and dorsally in 104 cases (57.4%), and passed through the IJV in five cases (2.8%). The SAN ran along the inner surface of the SCM and sent branches to the SCM without penetration of the muscle in 83 cases (45.9%), whereas in 98 cases (54.1%) the nerve sent branches to the SCM by penetration. Cervical plexus contribution to the SAN was seen from C2 in 96 cases (53.1%), C2 and C3 in 69 cases (38.1%), and C3 in 16 cases (8.8%). The mean number of LNs of level IIa and level IIb was 6.5 and 8.2 in cases in which the SAN crossed the IJV ventrally, and 6.8 and 5.4 in dorsally crossing cases. LNs included in the neck level IIb in ventrally crossing SAN cases were significantly larger than the dorsally crossing cases ( P < 0.05). Conclusions: Our results may help to minimize the incidence of injuring the SAN in the upper neck during ND. Neck level IIb would contain more LNs if the course of the nerve leans toward the ventral side.

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ANATOMICAL VARIATIONS OF SENSORY NERVE BRANCHES OF THE CERVICAL PLEXUS

International Journal of Anatomy and Research ◽

10.16965/ijar.2019.337 ◽

2019 ◽

Vol 7 (4.3) ◽

pp. 7182-7186

Author(s):

Nunes Drisana R ◽

◽

Santos Catharine NOB ◽

Nogueira Matheus S ◽

Bueno Nazareth F ◽

...

Keyword(s):

Sensory Nerve ◽

Anatomical Variations ◽

Cervical Plexus

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Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA ◽

10.1024/0301-1526/a000138 ◽

2011 ◽

Vol 40 (5) ◽

pp. 404-407

Author(s):

Maras ◽

Tzormpatzoglou ◽

Papas ◽

Papanas ◽

Kotsikoris ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Local Anaesthesia ◽

Anatomical Variation ◽

Anatomical Variations ◽

Circle Of Willis ◽

Variable Degree ◽

Operative Complications ◽

The Right ◽

Ica Stenosis ◽

Symptomatic Stenosis

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

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Nerve at Risk – Anatomical Variations of the Intrathoracic course of the Left Recurrent Laryngeal Nerve and its Implications for Thoracic Surgeons

10.1055/s-0039-1694167 ◽

2019 ◽

Author(s):

C Ng ◽

C Wöss ◽

H Maier ◽

V Schmidt ◽

P Lucciarini ◽

...

Keyword(s):

At Risk ◽

Recurrent Laryngeal Nerve ◽

Anatomical Variations ◽

Laryngeal Nerve ◽

Left Recurrent Laryngeal Nerve

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Regional Cervical Plexus Blockage for Carotid Endarterectomy in Patients with Cardiovascular Risk Factors

The Heart Surgery Forum ◽

10.1532/hsf.1385 ◽

2015 ◽

Vol 18 (4) ◽

pp. 140 ◽

Cited By ~ 2

Author(s):

Mehmet Taşar ◽

Mehmet Kalender ◽

Okay Güven Karaca ◽

Ata Niyazi Ecevit ◽

Salih Salihi ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Carotid Endarterectomy ◽

Regional Anesthesia ◽

Carotid Artery Disease ◽

Risk Groups ◽

Cardiac Risk ◽

Cervical Plexus ◽

Cardiac Risk Factors ◽

Significant Difference

Background: Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. Methods: We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared. Results: Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P > .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection. Conclusion: Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed.

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A Study of Anatomical Variations of Osteomeatal Complex in Correlation with Computed Tomography

Indian Journal Of Applied Research ◽

10.15373/2249555x/jan2014/130 ◽

2011 ◽

Vol 4 (1) ◽

pp. 428-429

Author(s):

Dr.M.Sasirekha Dr.M.Sasirekha ◽

◽

Dr.A.Ashokkumar Dr.A.Ashokkumar

Keyword(s):

Computed Tomography ◽

Anatomical Variations ◽

Osteomeatal Complex

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Anatomical Variations of the Left Subclavian Artery and Their Significance in Clinical Practice

Journal of Long-Term Effects of Medical Implants ◽

10.1615/jlongtermeffmedimplants.2020034579 ◽

2020 ◽

Vol 30 (1) ◽

pp. 3-12

Author(s):

Anna Botou ◽

Eleni Panagouli ◽

Maria Piagkou ◽

Paschalis Strantzias ◽

Stavros Angelis ◽

...

Keyword(s):

Clinical Practice ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Anatomical Variations

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Imaging study of the anatomical variations and the maxillary sinus pathology in patients with missing lateral teeth for the application of dental implants

ORL ro ◽

10.26416/orl.30.1.2016.517 ◽

2016 ◽

Vol 1 (1) ◽

pp. 6-12

Author(s):

Iulian Damian ◽

Gheorghe-Ionel Comșa

Keyword(s):

Computed Tomography ◽

Maxillary Sinus ◽

Dental Implants ◽

Preoperative Evaluation ◽

Anatomical Variations ◽

Accurate Information ◽

Maxillary Artery ◽

Lateral Sinus ◽

Sinus Wall ◽

Increased Risk

Preoperative evaluation of maxillary sinus anatomy is very important to avoid surgical complications due to close anatomical relations between the sinus and the posterior maxillary teeth and/or edentulous alveolar ridge. Posterior superior alveolar artery is a branch of the maxillary artery and provides the vascularization of the lateral sinus wall and underlying mucosa. Maxillary artery branches should be taken into consideration during sinus lifting procedures and bone augmentation due to increased risk of bleeding by damaging the artery during the osteotomy. Computed tomography (CT) explores three-dimensional anatomic structures and provides complex and accurate information about them. Cone Beam Computed Tomography (CBCT) offers an accurate view of the teeth and surrounding structures at high resolution, despite low-dose radiation used. In this study, the incidence of anatomical variations and sinus pathology were assessed using CBCT. The aim is to evaluate the presence of sinus pathology (sinus mucosal thickening, oro-antral communications, sinus tumors, cysts, polyps), presence and position of the posterior superior alveolar artery. These issues are important because they are about the limits of the dental implants in the posterior maxillary area. The presence of sinus pathology and anatomical variations may predispose to complications and even failures of implantation therapy.

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