THE ACCESSORY NERVE AND THE CERVICAL PLEXUS: ANATOMY AND CLINICAL IMPLICATIONS

Hand Surgery ◽  
1996 ◽  
Vol 01 (02) ◽  
pp. 113-121
Author(s):  
Wing-Cheung Wu ◽  
Ying-Lee Lam ◽  
Yun-Po Chang ◽  
Kai-Chung Poon ◽  
Kin-Ming Au
Keyword(s):  
Brachial Plexus ◽  
Trapezius Muscle ◽  
Accessory Nerve ◽  
Clinical Implications ◽  
Brachial Plexus Palsy ◽  
Cervical Plexus ◽  
Motor Branch ◽  
Applied Anatomy ◽  
Deep Branch ◽  
Posterior Triangle

The accessory nerve and the motor branch of the cervical plexus have been used as donor nerves in neurotisation procedures for brachial plexus palsy. However, there are few reports in the literature that describe their anatomy in detail. The aim of this study is to delineate the applied anatomy of these nerves. We emphasise their course in the posterior triangle of the neck as well as within the trapezius muscle. Fourteen cadavers were dissected. We identified nerves not reported before and they are the lateral cutaneous branches of C3 and C4. The deep branch of C4 is present in all the cases; it supplies the trapezius muscle and we believe it contains motor fibres. The accessory nerve gives a branch in the neck in only one case. The accessory nerve joins the deep branch of C4 in 93.3% of the cases. Clinical implications of the findings would be discussed.

Transfer of the Platysma Motor Branch to the Accessory Nerve in a Patient With Trapezius Muscle Palsy and Total Avulsion of the Brachial Plexus

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. E567-E570 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Brachial Plexus ◽  
Motor Nerve ◽  
Trapezius Muscle ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Suprascapular Nerve ◽  
Accessory Nerve ◽  
Shoulder Abduction ◽  
Motor Branch ◽  
Upper Trapezius

Abstract BACKGROUND AND IMPORTANCE: To report on the successful use of a platysma motor nerve transfer to the accessory nerve in a patient with concomitant trapezius and brachial plexus palsy. CLINICAL PRESENTATION: A 20-year-old man presented with total avulsion of the right brachial plexus combined with palsies of the accessory and phrenic nerve. The patient was operated on 4 months after his injury. The accessory nerve was repaired via direct transfer of the platysma motor branch. The contralateral C7 root was connected to the musculocutaneous nerve, and the hemihypoglossal nerve was grafted to the suprascapular nerve. Two intercostal nerves were attached to the triceps long head motor branch. CONCLUSION: Within 20 months of surgery, the patient regained full reinnervation of the upper trapezius muscle. Elbow flexion scored M3+, and 30° active shoulder abduction was observed. Triceps reinnervation was poor. Platysma motor branch transfer to the accessory nerve is a viable alternative to reinnervate the trapezius muscle.

The Spinal Accessory Nerve Distal to the Posterior Triangle

1999 ◽  
Vol 24 (3) ◽  
pp. 368-369 ◽  
Author(s):  
M. T. PEREIRA ◽  
W. W. WILLIAMS
Keyword(s):  
Trapezius Muscle ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Clinical Implications ◽  
Spinal Accessory ◽  
Deep Surface ◽  
Posterior Triangle

Thirty cadaver necks were dissected to determine the course of the accessory nerve distal to the posterior triangle. The nerve was found to have a constant course on the deep surface of the trapezius muscle. This has clinical implications for surgery in the region.

Combined Injury of the Accessory Nerve and Brachial Plexus

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. 390-396 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Electrical Stimulation ◽  
Brachial Plexus ◽  
Nerve Palsy ◽  
Head Tilt ◽  
Trapezius Muscle ◽  
Sternocleidomastoid Muscle ◽  
Accessory Nerve ◽  
Surgical Reconstruction ◽  
Motor Branch ◽  
Upper Trapezius

Abstract BACKGROUND: Stretch-induced spinal accessory nerve palsy has been considered extremely rare, with only a few cases reported. OBJECTIVE: In 357 patients with stretch lesions of the brachial plexus, we investigated the prevalence, course, and surgical treatment of accessory nerve palsy. METHODS: Accessory nerve palsy was ascertained when the patient was unable to shrug the ipsilateral shoulder. Patients underwent brachial plexus reconstruction between 6 and 8 months after trauma. To confirm paralysis, during surgery, the accessory nerve was stimulated electrically. RESULTS: Accessory nerve palsy occurred in 19 of the 327 patients (6%) with upper type or complete palsy of the brachial plexus. Proximal injuries of the accessory nerve accompanied by voice alteration and complete palsy of the sternocleidomastoid and trapezius muscle occurred in 2 patients. Proximal palsy without vocal alterations was observed in 6 patients. Palsy of the trapezius muscle with preservation of the sternocleidomastoid muscle occurred in 11 patients. All 7 patients who demonstrated muscle contractions upon electrical stimulation of the accessory nerve during surgery recovered completely. Patients with surgical reconstruction of the accessory nerve through grafting (n = 2) or repair by platysma motor nerve transfer (n = 2) recovered active shoulder shrugging within 36 months of surgery. Seven of the 8 patients without accessory nerve reconstruction recovered from their drop shoulder and head tilt, but remained unable to shrug. CONCLUSION: If intraoperative electrical stimulation produces contraction of the upper trapezius muscle, no repair is needed. In proximal injuries, the platysma motor branch should be transferred to the accessory nerve; whereas in paralysis distal to the sternocleidomastoid muscle, the accessory nerve should be explored and grafted.

Spinal to accessory nerve transfer in traumatic brachial plexus palsy: is body mass index a predictor of outcome?

2013 ◽  
Vol 156 (1) ◽  
pp. 159-163 ◽  
Author(s):  
Mariano Socolovsky ◽  
Gilda Di Masi ◽  
Gonzalo Bonilla ◽  
Martijn Malessy
Keyword(s):  
Body Mass Index ◽  
Brachial Plexus ◽  
Body Mass ◽  
Nerve Transfer ◽  
Accessory Nerve ◽  
Brachial Plexus Palsy

Improved Technique for Harvesting the Accessory Nerve for Transfer in Brachial Plexus Injuries

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-366-ONS-370 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flavio Ghizoni
Keyword(s):  
Brachial Plexus ◽  
Lymphatic Vessels ◽  
Trapezius Muscle ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Accessory Nerve ◽  
Fat Tissue ◽  
Anterior Border ◽  
Improved Technique ◽  
Nerve Identification

Abstract Objective: The accessory nerve is frequently used as a donor for nerve transfer in brachial plexus injuries. In currently available techniques, nerve identification and dissection is difficult because fat tissue, lymphatic vessels, and blood vessels surround the nerve. We propose a technique for location and dissection of the accessory nerve between the deep cervical fascia and the trapezius muscle. Methods: Twenty-eight patients with brachial plexus palsy had the accessory nerve surgically transplanted to the suprascapular nerve. To harvest the accessory nerve, the anterior border of the trapezius muscle was located 2 to 3 cm above the clavicle. The fascia over the trapezius muscle was incised and detached from the anterior surface of the muscle, initially, close to the clavicle, then proximally. The trapezius muscle was detached from the clavicle for 3 to 4 cm. The accessory nerve and its branches entering the trapezius muscle were identified. The accessory nerve was sectioned as distally as possible. To allow for accessory nerve mobilization, one or two proximal branches to the trapezius muscle were cut. The most proximal branch was always identified and preserved. A tunnel was created in the detached fascia, and the accessory nerve was passed through this tunnel to the brachial plexus. Results: In all of the cases, the accessory nerve was easily identified under direct vision, without the use of electric stimulation. Direct coaptation of the accessory nerve with the suprascapular nerve was possible in all patients. Conclusion: The technique proposed here for harvesting the accessory nerve for transfer made its identification and dissection easier.

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.

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