86 A Cadaveric Study of the Motor Nerves to the Levator Scapulae

1995 ◽  
Vol 113 (2) ◽  
pp. P184-P185
Author(s):  
Douglas K. Frank ◽  
Eugene Wenk ◽  
Jordan C. Stern ◽  
Ron D. Gottlieb
Keyword(s):  
Surgical Anatomy ◽  
Posterior Border ◽  
Cervical Plexus ◽  
Anterior Border ◽  
Shoulder Dysfunction ◽  
Posterior Triangle ◽  
Levator Scapulae ◽  
Prevertebral Fascia ◽  
Motor Nerves ◽  
The Difference

Objective: Avoiding injury to the motor nerves of the levator scapulae muscle during neck dissection surgery should reduce postoperative shoulder dysfunction. Understanding the surgical anatomic relationships of these motor nerves is imperative for reducing this morbidity. This study was undertaken to elucidate this relevant anatomy, because the surgical and anatomic literature lack adequate description. Methods: Cervical (C3, C4) and brachial (C5 via dorsal scapular nerve) plexi contributions of the levator scapulae were assessed with respect to posterior triangle landmarks in 37 human cadaveric necks. Results: An average of approximately two (actual 1.92) nerves from the cervical plexus (range, one to four nerves) emerged from beneath the posterior border of the sternocleidomastoid to innervate the levator scapulae. The two most superior cervical plexus contributions to the levator scapulae emerged from the posterior border of the sternocleidomastoid on average 21.94 mm and 25.68 mm, respectively, caudal to the emergence of cranial nerve XI. These same cervical plexus nerves on average emerged from the posterior border of the sternocleidomastoid 10.32 mm and 14.64 mm, respectively, caudal to the punctum nervosum. An average of approximately two (actual, 1.94) nerves from the cervical plexus (range, one to three nerves) crossed the anterior border of the levator scapulae to either innervate this muscle on its superficial surface or just at its anterior border. Cervical plexus contributions crossed the anterior border of the levator scapulae in a superior to inferior progression. The two most superior contributions crossed the anterior border of the levator scapulae on average 15.03 mm. and 21.50 mm. respectively inferior to this muscle's intersection with the sternocleidomastoid. In any given neck specimen, cervical plexus nerves emerging from the posterior border of the sternocleidomastoid in route to the levator scapulae could branch or come together, which explains the difference in the average number of nerves that crossed the anterior border of the levator scapulae compared with the average number that emerged from the posterior border of the sternocleidomastoid. On average, the dorsal scapular nerve after piercing scalenus medius crossed deep to the anterior border of the levator scapulae 43.23 mm inferior to this muscle's intersection with the sternocleidomastoid. All innervation to the levator was deep to the prevertebral fascia. Among study parameters, statistically significant ( p <0.05) differences were not encountered between right and left necks. Conclusions: The levator scapulae receives predictable motor supply from the cervical and brachial plexi. Our data elucidate surgical anatomy useful to head and neck surgeons.

Surgical Anatomy of Spinal Accessory Nerve: Is Trapezius Functional Deficit Inevitable after Division of the Nerve?

2001 ◽  
Vol 26 (2) ◽  
pp. 137-141 ◽  
Author(s):  
Z. H. DAILIANA ◽  
H. MEHDIAN ◽  
A. GILBERT
Keyword(s):  
Nerve Transfer ◽  
Surgical Anatomy ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Cervical Plexus ◽  
Spinal Accessory ◽  
Iatrogenic Injuries ◽  
Functional Deficit ◽  
Posterior Triangle ◽  
Transfer Procedures

The course of spinal accessory nerve in the posterior triangle, the innervation of the sternocleidomastoid and trapezius muscles and the contributions from the cervical plexus were studied in 20 cadaveric dissections. The nerve was most vulnerable to iatrogenic injuries after leaving the sternocleidomastoid. Direct innervation of trapezius by cervical plexus branches was noted in five dissections, whereas connections between the cervical plexus and the spinal accessory nerve were observed in 19 dissections. These were usually under the sternocleidomastoid (proximal to the level of division of the nerve in nerve transfer procedures). Although the contribution from the cervical plexus to trapezius innervation is considered minimal, trapezius function can be protected in neurotization procedures by transecting the spinal accessory nerve distal to its branches to the upper position of trapezius.

Surgical anatomy of the dorsal scapular nerve

2005 ◽  
Vol 102 (5) ◽  
pp. 910-911 ◽  
Author(s):  
R. Shane Tubbs ◽  
Elizabeth C. Tyler-Kabara ◽  
Alan C. Aikens ◽  
Justin P. Martin ◽  
Leslie L. Weed ◽  
...  
Keyword(s):  
Trapezius Muscle ◽  
Spinal Nerve ◽  
Surgical Anatomy ◽  
Anterior Border ◽  
Content Type ◽  
Levator Scapulae ◽  
Human Cadavers ◽  
Relationship Of ◽  
The Relationship ◽  
Fine Print

Object. There is a paucity of literature regarding the surgical anatomy of the dorsal scapular nerve (DSN). The aim of this study was to elucidate the relationship of this nerve to surrounding anatomical structures. Methods. Ten formalin-fixed human cadavers (20 sides) were dissected, and measurements made between the DSN and related structures. The nerve pierced the middle scalene muscle at a mean distance of 3 cm from its origin from the cervical spine and was more or less centrally located at this exit site. It lay a mean distance of 1.5 cm medial to the vertebral border of the scapula between the serratus posterior superior, posterior scalene, and levator scapulae muscles. It was found to have a mean distance of 2.5 cm medial to the spinal accessory nerve as it traveled on the anterior border of the trapezius muscle. The nerve intertwined the dorsal scapular artery in all specimens and was found along the anterior border of the rhomboid muscles. On 19 sides the DSN originated solely from the C-5 spinal nerve, and on one side it arose from the C-5 and C-6 spinal nerves. Conclusions. Knowledge of the anatomy of the DSN will aid the surgeon who wishes to explore and decompress this structure.

The spatial and temporal dynamics of Sax1 (CHox3) homeobox gene expression in the chick's spinal cord

Development ◽  
1994 ◽  
Vol 120 (7) ◽  
pp. 1817-1828 ◽  
Author(s):  
P. Spann ◽  
M. Ginsburg ◽  
Z. Rangini ◽  
A. Fainsod ◽  
H. Eyal-Giladi ◽  
...  
Keyword(s):  
Temporal Dynamics ◽  
Homeobox Gene ◽  
Primitive Streak ◽  
Neural Plate ◽  
Transverse Plane ◽  
Posterior Border ◽  
Anterior Border ◽  
Spatial And Temporal Dynamics ◽  
Specific Localization

Sax1 (previously CHox3) is a chicken homeobox gene belonging to the same homeobox gene family as the Drosophila NK1 and the honeybee HHO genes. Sax1 transcripts are present from stage 2 H&H until at least 5 days of embryonic development. However, specific localization of Sax1 transcripts could not be detected by in situ hybridization prior to stage 8-, when Sax1 transcripts are specifically localized in the neural plate, posterior to the hindbrain. From stages 8- to 15 H&H, Sax1 continues to be expressed only in the spinal part of the neural plate. The anterior border of Sax1 expression was found to be always in the transverse plane separating the youngest somite from the yet unsegmented mesodermal plate and to regress with similar dynamics to that of the segregation of the somites from the mesodermal plate. The posterior border of Sax1 expression coincides with the posterior end of the neural plate. In order to study a possible regulation of Sax1 expression by its neighboring tissues, several embryonic manipulation experiments were performed. These manipulations included: removal of somites, mesodermal plate or notochord and transplantation of a young ectopic notochord in the vicinity of the neural plate or transplantation of neural plate sections into the extraembryonic area. The results of these experiments revealed that the induction of the neural plate by the mesoderm has already occurred in full primitive streak embryos, after which Sax1 is autonomously regulated within the spinal part of the neural plate.

scholarly journals THE DISCRIMINATE ABILITY OF THE PEDIATRIC ADOLESCENT SHOULDER SURVEY (PASS)

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0018
Author(s):  
Tracey Bastrom ◽  
Andrew Pennock ◽  
Eric W. Edmonds
Keyword(s):  
Surgical Treatment ◽  
Shoulder Instability ◽  
Shoulder Function ◽  
Compensatory Mechanisms ◽  
Minimal Impact ◽  
Shoulder Dysfunction ◽  
Operative Outcomes ◽  
The Difference

Purpose: The purpose of this study was to examine whether improvements in the Pediatric and Adolescent Shoulder Survey (PASS) are seen at 3 months following surgical treatment for shoulder instability and whether the PASS can discriminate between patients with differing outcomes based on clinical exam and the single assessment numeric evaluation (SANE). Performance of the PASS was contrasted with an adult validated tool, the quickDASH. Methods: Patients who underwent surgical treatment for shoulder instability with completed PASS forms available at pre-operative and 3 months post-operative (range 2.5-4.5mos) were included in this review. The PASS consists of 13 questions that assess (in child friendly language) symptoms, limitations, need for compensatory mechanisms, and emotional distress related to shoulder dysfunction. Responses are on a 0-5 or 0-10 scale with a score calculation based on percentage of total possible points (100% indicates no/minimal impact on quality of life from shoulder dysfunction). Patients were grouped based on range of motion or strength (within 10 degrees to contralateral extremity or no discrepancy in strength score was considered no deficit) and SANE score (=80% vs <80%) at the 3-month visit. Alpha was set at p<0.05 to declare significance. Results: 50 patients with a mean age of 16 years (range 13.5-18 yrs) were identified in this review with a mean post-operative follow-up of 3.2 ± 0.5 months. Scores on the PASS improved significantly from pre-operative (57 ± 16%) to post-operative (74 ± 16%, p<0.001). The quickDASH similarly showed improvement (27 ± 16 pre vs 18 ± 16 post, p=0.003) although the magnitude of the effect for the PASS was larger (f=0.84 for PASS vs f=0.48 for quickDASH). Ceiling effect (>15% reporting the highest score) was observed at 3 months with the quickDASH (16% with top score), but not with the PASS (4%, p=0.03). While both tools were able to discriminate between patients with SANE score =80% vs <80%, the difference in quickDASH score between patients with/without diminished motion did not reach significance (p=0.07, Table). Conclusion: The PASS shows anticipated improvements in shoulder function following surgical intervention for instability without ceiling effects. The PASS is able to discriminate between patients with differing post-operative outcomes at 3 months following surgery. [Table: see text]

Ectopic salivary gland in the posterior triangle of the neck

1995 ◽  
Vol 109 (7) ◽  
pp. 669-670 ◽  
Author(s):  
J. N. Marshall ◽  
G. Soo ◽  
F. V. Coakley
Keyword(s):  
Differential Diagnosis ◽  
Salivary Gland ◽  
Duct System ◽  
Anterior Border ◽  
Posterior Triangle ◽  
Branchial Sinus

AbstractEctopic cervical salivary tissue may present as a discharging sinus if a duct system and cutaneous orifice are present. Where described in previous reports these openings have been located along the anterior border of sternomastoid or in the anterior triangle, making this a differential diagnosis of a branchial sinus. We report on a patient who presented with an ectopic salivary gland in the posterior triangle of the neck.

scholarly journals BARE SPOT LOCATION IN GLENOID CAVITY: COMPARISON BETWEEN ARTHROSCOPY AND CT SCAN

2020 ◽  
Vol 28 (5) ◽  
pp. 243-246
Author(s):  
MAX ROGÉRIO FREITAS RAMOS ◽  
PEDRO FILGUEIRAS HIDALGO ◽  
DIOGO FAGUNDES ◽  
YONDER ARCHANJO CHING SAN JUNIOR
Keyword(s):  
Posterior Margin ◽  
Three Dimensional ◽  
Glenoid Cavity ◽  
Posterior Border ◽  
Posterior Edge ◽  
Anterior Border ◽  
Level Of Evidence ◽  
Injury Repair ◽  
Bare Spot ◽  
Dimensional Reconstruction

ABSTRACT Objective: To assess whether Bare Spot is previously displaced by proportion (MEASURE BP-A × 1.25/MEASURE BP-P = 1). Methods: 35 patients with surgical indication for rotator cuff injury repair were evaluated. The distances from the Bare Spot to the anterior edge of the glenoid cavity (BS-A) and to the posterior edge (BS-P) were measured by arthroscopy and computed tomography with three-dimensional reconstruction of the scapula. Results: The distance from the Bare Spot to the anterior border (BS-A tc) was 11.6 mm with a median 12 mm; The distance to the posterior border (BS-P tc) was on average 15.5 mm with a median 15 mm. The distances from BS to anterior cavity edge measured by arthroscopy were on average (BS-A video) 12.25 mm with a median of 12 mm, and from BS to posterior edge (BS-P video) 16.25 mm on average with median 16 mm (p < 0.005). Conclusion: Bare Spot is displaced anteriorly at a proportion of 40% of the anterior margin and 60% of the posterior margin. Level of Evidence II - Development of diagnostic criteria on consecutive patients (with universally applied reference “gold standard”).

A COMPARATIVE STUDY OF COMPLICATIONS OF MRM (MODIFIED RADICAL MASTECTOMY) VERSUS BCS (BREAST CONSERVATION THERAPY) IN EARLY INVASIVE BREAST CANCER. A RESULT FROM SAVERA CANCER AND MULTISPECIALITY HOSPITAL PATNA, BIHAR.

2021 ◽  
pp. 66-67
Author(s):  
Vijay Pratap Singh ◽  
Akash Singh ◽  
Pranab Kumar Verma ◽  
Vishal Mohan Singh ◽  
Arun Kumar Jha
Keyword(s):  
Breast Cancer ◽  
Statistical Analysis ◽  
Breast Tissue ◽  
Breast Conservation ◽  
Surgical Margin ◽  
Radical Mastectomy ◽  
P Value ◽  
Shoulder Dysfunction ◽  
The Difference

Background: Early breast cancer patients admitted in the surgical oncology department of Savera Cancer and Multispeciality Hospital. Patients were divided in two treatment arms; Arm A and Arm B. Arm A patient went through MRM and Arm B patients went through BCS. This study included prospective cases of 1 year from June 2019 to June 2020. Method: In all MRM group patients all breast tissue, skin, nipple areola complex and level 1, 2, 3 lymph nodes removed. In all BCS group patients lump was removed with an envelope of normal appearing breast tissue. In all resected specimens free surgical margin was ensured via histopathology reports (HPR). Patients were reviewed in early post operative period for complications and follow up done at the end of 1st, 3rd, 6th and 12th month for recurrence. In treatment Arm A (MRM) 08 patients developed arm ede Result: ma; 05 patients developed shoulder dysfunction; 07 patients developed ap necrosis; 07 patients developed arm dysesthesia. Whether in treatment ARM B (BCT) 04 patient had Seroma formation; 13 patients developed wound infection & wound contracture. Complications were reported in 35% of MRM group (35 out of 100 cases), while they were absent in 65% (65 out of 100). However, in the BCS group, complications were reported in 6.66% cases only (15 out of 100 cases), while were absent in 93.33% (75 out of 100). P value by statistical analysis being 0.283, the difference being statistically insignicant. Recurrence were present in 6.66% of MRM group (8/100) while they were absent in 92.34 % (92/100). However in BCS group recurrences were present in 3.33 % (3/100) and were absent in 97.67% (97/100). P value by statistical analysis being 1, the difference being statistically insignicant. Grading of complications has been captured from CTCAE Version 5.0 (Common Terminology Criteria for Adverse Events). Conclusion: There is slight signicant difference in the recurrence rate, whether the patient had undergone BCS or MRM based on our short term follow-up. However a long term follow-up is required.

scholarly journals A New Formica from Northern Maine, with a Discussion of its Supposed Type of Social Parasitism (Hymenoptera: Formicidae)

1949 ◽  
Vol 81 (1) ◽  
pp. 13-17 ◽  
Author(s):  
M. W. Wing
Keyword(s):  
Social Parasitism ◽  
Isosceles Triangle ◽  
Frontal Area ◽  
Medium Size ◽  
Posterior Border ◽  
Uneven Surface ◽  
Anterior Border ◽  
Maximum Width ◽  
Strongly Convex ◽  
Basal Half

While on a short visit in northern Maine during the summer of 1946, I collected a new and interesting ant of the Microgyna group of the genus Formica. The description follows below:Formica dirksi sp. nov.Deälate queen, total length 5.1 mm. Head, maximum width through eyes 1.2 mm., at base of mandibles 0.78 mm., length to anterior border of clypeus 1.3 mm. Thorax, Weber's (1938: 155, footnote) measurement 2.1 mm. General characters of the Microgyna group. Mandibles 7-toothed. Clypeus evenly rounded in front, with uneven surface and carina just barely distinguishable as a line anteriorly, but becoming a low blunt ridge through the mid-region and disappearing posteriorly. Head, excluding mandibles and eyes, somewhat longer than broad; narrower in front than in behind, with posterior corners evenly rounded, posterior border and sides slightly convex. Antennae of medium size, scape slightly stouter apically than basally, bent slightly and gradually in basal half, joints 2 and 3 of funiculus distinctly longer than broad; the apical joints only slightly longer than broad. Frontal area distinct, subtriangular, and about twice as broad at base as high. Frontal carinae diverging posteriorly, about as long as width of frontal area. Eyes black, more or less oval, strongly convex, remote from mandibular insertions and close to posterior corners of head. Ocelli medium-sized, round, white and forming an isosceles triangle with a base, which is situated posteriorly, equal to 0.24 mm. Ratio of base to the shorter sides is 10 to 7.

Selective denervation of the levator scapulae muscle: an amendment to the Bertrand procedure for the treatment of spasmodic torticollis

2008 ◽  
Vol 108 (4) ◽  
pp. 757-763 ◽  
Author(s):  
William S. Anderson ◽  
Herman Christopher Lawson ◽  
Allan J. Belzberg ◽  
Frederick A. Lenz
Keyword(s):  
Cervical Spine ◽  
Posterior Approach ◽  
Spasmodic Torticollis ◽  
Sternocleidomastoid Muscle ◽  
Nerve Supply ◽  
Anterior Surface ◽  
Nerve Roots ◽  
Posterior Triangle ◽  
Levator Scapulae ◽  
Levator Scapulae Muscle

Object The purpose of this cadaveric study was to explore a modification to the Bertrand procedure for the treatment of spasmodic torticollis, namely the denervation of the levator scapulae (LS) muscle for laterocollis. Methods The authors performed a series of 9 cadaveric dissections. Five were done to identify the anterior innervation of the LS, and the remaining 4 were to identify the tendinous insertions of the LS onto the lateral masses of the cervical spine via a posterior approach. The nerve supply to the LS from the anterior divisions of the C-3 and C-4 nerve roots and the contribution from the dorsal scapular nerve were identified over the anterior surface of the muscle. Results The C-3 and C-4 nerve root branches were situated within 2 cm of each other and inferior to the punctum nervosum. The dorsal scapular contribution was clearly identified in 2 cadavers. Selective denervation of this muscle is possible through the same posterior triangle incision used for denervating the sternocleidomastoid muscle of its accessory nerve branches. This approach will be helpful in patients with laterocollis contralateral to the direction of chin turning. The authors compare this approach to the posterior approach for sectioning the insertions of the LS muscle onto the C1–4 posterior tubercles. The latter approach is appropriate for ipsilateral laterocollis. Conclusions The posterior triangle approach for denervating the LS muscle is a safe and easy addition to the Bertrand procedure and can be helpful in selected cases of torticollis with a laterocollis component.

Sign in / Sign up

Export Citation Format

Share Document