In-Depth Look at the Anatomical Relationship of the Lesser Occipital Nerve, Great Auricular Nerve, and Spinal Accessory Nerve and Their Implication in Safety of Operations in the Posterior Triangle of the Neck

2020 ◽  
Vol 146 (3) ◽  
pp. 509-514
Author(s):  
Bardia Amirlak ◽  
Karen B. Lu ◽  
Cameron R. Erickson ◽  
Kyle Sanniec ◽  
Ali Totonchi ◽  
...  
Keyword(s):  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Occipital Nerve ◽  
Spinal Accessory ◽  
Posterior Triangle ◽  
Great Auricular Nerve ◽  
Anatomical Relationship ◽  
Relationship Of

The X-pointer: A forgotten anatomical relationship of spinal accessory nerve and great auricular nerve

2021 ◽  
Vol 37 ◽  
pp. 101522
Author(s):  
Vishal Rao ◽  
Anand Subash ◽  
Piyush Sinha ◽  
Sataksi Chatterjee ◽  
Ravi C. Nayar
Keyword(s):  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
Great Auricular Nerve ◽  
Anatomical Relationship ◽  
Relationship Of

scholarly journals A Rare Anatomical Relationship of Spinal Accessory Nerve to Internal Jugular Vein

2011 ◽  
Vol 2 (2) ◽  
pp. 119-120
Author(s):  
Prahlad Duggal ◽  
Amit Dhawan ◽  
Sumeet Sandhu
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Anatomical Variations ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
First Case ◽  
Level Ii ◽  
Anatomical Relationship ◽  
Relationship Of

ABSTRACT A patient with a squamous cell carcinoma of right retromolar area of the mandible and undergoing a staging neck dissection was noted to have a unique relationship of the internal jugular vein and spinal accessory nerve. At the upper end of the dissection (level II, Memorial Sloan-Kettering classification), the spinal accessory nerve was observed to pass directly through the internal jugular vein. Although previously described only once in the literature, this finding may be encountered by other surgeons who operate in this area and it is important that these anatomical variations are borne in mind to prevent inadvertent injury. To our knowledge, this must be the first case reported from India.

scholarly journals A Rare Anatomical Relationship of Spinal Accessory Nerve to Internal Jugular Vein

2012 ◽  
Vol 3 (1) ◽  
pp. 40-41
Author(s):  
Prahlad Duggal ◽  
Amit Dhawan ◽  
Sumeet Sandhu
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Anatomical Variations ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
First Case ◽  
Level Ii ◽  
Anatomical Relationship ◽  
Relationship Of

ABSTRACT A patient with squamous cell carcinoma of right retromolar area of the mandible and undergoing a staging neck dissection was noted to have a unique relationship of the internal jugular vein and spinal accessory nerve. At the upper end of the dissection (level II, Memorial Sloan-Kettering classification), the spinal accessory nerve was observed to pass directly through the internal jugular vein. Although previously described only once in the literature, this finding may be encountered by other surgeons who operate in this area and it is important that these anatomical variations are borne in mind to prevent inadvertent injury. To our knowledge, this must be the first case reported from India. How to cite this article Dhawan A, Duggal P, Sandhu S. A Rare Anatomical Relationship of Spinal Accessory Nerve to Internal Jugular Vein. Int J Head and Neck Surg 2012;3(1): 40-41.

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 challenges associated with the morphology of the spinal accessory nerve in the posterior cervical triangle: functional or structural?

2010 ◽  
Vol 12 (1) ◽  
pp. 22-24 ◽  
Author(s):  
R. Shane Tubbs ◽  
William Stetler ◽  
Robert G. Louis ◽  
Ankmalika A. Gupta ◽  
Marios Loukas ◽  
...  
Keyword(s):  
Peripheral Nerves ◽  
Histological Analysis ◽  
Cranial Nerves ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
Posterior Triangle ◽  
Structural Forces ◽  
Injury And Repair ◽  
Insight Into

Object The spinal accessory nerve (SAN) has been reported to have a distinctly coiled appearance in its course through the posterior cervical triangle of the neck. As this is unusual compared with other peripheral nerves including the cranial nerves, the present histological analysis was performed to further elucidate the reason for this anatomy with potential application in nerve injury and repair. Methods Ten adult cadavers underwent dissection of the neck. The SAN was harvested proximally and within the posterior cervical triangle. For comparison with other cranial nerves within the neck, the cervical vagus and hypoglossal nerves were also harvested. All nerves underwent histological analysis. Additionally, 2 human fetuses (11 and 20 weeks' gestation) underwent examination of the SAN in the posterior cervical triangle, and 3 randomly selected specimens were submitted for electromicroscopy. Results All SANs were found to have a straight gross configuration proximal to the posterior triangle and a coiled appearance within this geometrical area. Histologically, no differences were identified for the SAN in these 2 locations (that is, proximal to and within the posterior cervical triangle). The histology of the SAN both with routine analysis and electron microscopy was similar in both regions and to nerves used as controls (for example, vagus and hypoglossal nerves). Interestingly, both fetal specimens were found to have coiled SANs in the posterior cervical triangle. Conclusions Based on this study, it appears that the tortuous course of the SAN in the posterior triangle arises from functional as opposed to structural forces. It is hoped that this analysis will provide some insight into the nature behind the morphology observed in the SAN within the posterior cervical triangle and aid in future investigations regarding its injury. Moreover, such a coiled nature of this nerve may assist the neurosurgeon in identifying it during, for example, neurotization procedures.

Nerve fascicle transfer using a part of the C-7 nerve for spinal accessory nerve injury

2018 ◽  
Vol 28 (5) ◽  
pp. 555-561 ◽  
Author(s):  
Xuan Ye ◽  
Yun-Dong Shen ◽  
Jun-Tao Feng ◽  
Wen-Dong Xu
Keyword(s):  
Trapezius Muscle ◽  
Nerve Transfer ◽  
Jugular Foramen ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
Linear Distance ◽  
Anatomical Relationship ◽  
Nerve Fascicle ◽  
Posterior Division

OBJECTIVESpinal accessory nerve (SAN) injury results in a series of shoulder dysfunctions and continuous pain. However, current treatments are limited by the lack of donor nerves as well as by undesirable nerve regeneration. Here, the authors report a modified nerve transfer technique in which they employ a nerve fascicle from the posterior division (PD) of the ipsilateral C-7 nerve to repair SAN injury. The technique, first performed in cadavers, was then undertaken in 2 patients.METHODSSix fresh cadavers (12 sides of the SAN and ipsilateral C-7) were studied to observe the anatomical relationship between the SAN and C-7 nerve. The length from artificial bifurcation of the middle trunk to the point of the posterior cord formation in the PD (namely, donor nerve fascicle) and the linear distance from the cut end of the donor fascicle to both sites of the jugular foramen and medial border of the trapezius muscle (d-SCM and d-Traps, respectively) were measured. Meanwhile, an optimal route for nerve fascicle transfer (NFT) was designed. The authors then performed successful NFT operations in 2 patients, one with an injury at the proximal SAN and another with an injury at the distal SAN.RESULTSThe mean lengths of the cadaver donor nerve fascicle, d-SCM, and d-Traps were 4.2, 5.2, and 2.5 cm, respectively. In one patient who underwent proximal SAN excision necessitated by a partial thyroidectomy, early signs of reinnervation were seen on electrophysiological testing at 6 months after surgery, and an impaired left trapezius muscle, which was completely atrophic preoperatively, had visible signs of improvement (from grade M0 to grade M3 strength). In the other patient in whom a distal SAN injury was the result of a neck cyst resection, reinnervation and complex repetitive discharges were seen 1 year after surgery. Additionally, the patient’s denervated trapezius muscle was completely resolved (from grade M2 to grade M4 strength), and her shoulder pain had disappeared by the time of final assessment.CONCLUSIONSNFT using a partial C-7 nerve is a feasible and efficacious method to repair an injured SAN, which provides an alternative option for treatment of SAN injury.

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