scholarly journals Incidence of Accessory Phrenic Nerve and its Clinical Significance: A Cadaveric Study

2008 ◽  
Vol 51 (3) ◽  
pp. 181-184 ◽  
Author(s):  
Soubhagya R. Nayak ◽  
Ashwin Krishnamurthy ◽  
Latha V. Prabhu ◽  
Lakshmi Ramanathan ◽  
Mangala M. Pai ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Phrenic Nerve ◽  
Subclavian Vein ◽  
Indian Population ◽  
Internal Thoracic Artery ◽  
Gross Anatomy ◽  
Neck Surgery ◽  
Cervical Region ◽  
Thoracic Region ◽  
Formalin Fixed

The description of accessory phrenic nerve (APN) in the standard textbooks and available literature is vague and sometimes limited to few lines. The incidence of APN varies a great deal from 17.6 % to 80.9 % in the available literature. The aim of the present study was to calculate the incidence and variation of APN in Indian population. Material and methods: Forty five adult formalin-fixed cadavers (35 male, 10 female; 90 sides) used for gross anatomy dissection for undergraduates; during the 2 year period 2006–2007 were considered. Findings were recorded at different stages of the dissection. Results: Out of 90 body sides studied, the APN was present in 48 sides (53.3 %). In 17 of the above sides the APN was confined to the cervical region (Cervical type) and in 31 sides the APN entered the thorax (Thoracic type), all anterior to the subclavian vein (SV). In eleven specimens the APN was found bilaterally. Conclusion: The incidence of APN, with its course and relation to the various structures in cervical and thoracic region will help the surgeons while performing internal thoracic artery (ITA) grafting and other radical neck surgery.

scholarly journals Anatomical variations of the phrenic nerve: an actualized review

2015 ◽  
Vol 32 (01) ◽  
pp. 053-056 ◽  
Author(s):  
A. Prates Júnior ◽  
L. Vasques ◽  
L. Bordoni
Keyword(s):  
Subclavian Artery ◽  
Phrenic Nerve ◽  
Subclavian Vein ◽  
Internal Thoracic Artery ◽  
Anatomical Variations ◽  
Surgical Anatomy ◽  
Diaphragm Muscle ◽  
Normal Anatomy ◽  
The Subject ◽  
Superior Portion

Abstract Introduction: The phrenic nerve normally arises from ventral rami of C3, C4 and C5. It emerges laterally to the superior portion oflateral border of scalenus anterior muscle and presents a descendent course between subclavian artery and vein. It crosses anterior to internal thoracic artery and descends through the mediastinum, until the diaphragm muscle, to supply it with motor and sensitive fibers. Matherials and Methods: A bibliographic review was conducted, based on anatomy, neuroanatomy and surgical anatomy textbooks, published in Brazil and abroad, as well as a review of scientific articles, published over the last 20 years, available on research databases PubMed, Scielo, LILACS and MEDLINE, from keywords phrenic nerve, variation and anomaly. Results: Variations of the phrenic nerve are frequent, but they are not often discussed. Thus, we aimed to conduct an actualized review over the subject. Regarding the variations in the origin of the phrenic nerve, textbooks vaguely inform that it is mainly formed by C4, but the recent cadaveric studies pointed the segments C4 and C5 as the most common origin. About the variations in its course, the most described is its passage anterior to the subclavian vein, before reaching the thorax. However, the presence of accessory phrenic nerve represents the greatestvariation, mostly arising from nerve to subclavian. There are few reports in literature about the complications associated to these variations, but some are suggested, as the possibility of causing its damage during the puncture of the subclavian vein, when the nerve descends anterior to it, which may lead to a hemidiaphragmatic paresis. When variations are present, even simple procedures may cause injuries. Conclusion: Therefore it is fundamental to know the normal anatomy and the possible variations of the phrenic nerve, in order to perform safe procedures in its topography, as well as to enable a timely recognition of complications.

Phrenic nerve palsy: a rare complication of indwelling subclavian vein catheter

2000 ◽  
Vol 14 (3) ◽  
pp. 203-204 ◽  
Author(s):  
S. Aggarwal ◽  
P. Hari ◽  
A. Bagga ◽  
S.N. Mehta
Keyword(s):  
Phrenic Nerve ◽  
Subclavian Vein ◽  
Nerve Palsy ◽  
Rare Complication ◽  
Phrenic Nerve Palsy ◽  
Vein Catheter

scholarly journals CADAVERIC ANATOMY AND RELATIONSHIP OF PHRENIC NERVE AND SUBCLAVIAN VEIN

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Dr. Sandeep Madaan ◽  
Dr. Lavlesh Mittal
Keyword(s):  
Phrenic Nerve ◽  
Subclavian Vein ◽  
Theoretical Data ◽  
Anterior Wall ◽  
Medical Sciences ◽  
Phrenic Nerve Palsy ◽  
Vein Wall ◽  
Clinical Interest ◽  
Relationship Of ◽  
Vein Catheterization

INTRODUCTION: Deep knowledge of anatomy is an essential part of surgical practice. Students of medical sciences gain knowledge and theoretical data through actual visualization of anatomic structures of the cadavers also anatomic relations can be studied more efficiently by practicing on cadavers. As phrenic nerve may be damaged during subclavian vein catheterization the relationship between the phrenic nerve and the subclavian vein is of clinical interest. During the subclavian vein catheterization analogous variable relationships are helpful to explain and prevent damage to the phrenic nerve. MATERIAL AND METHODS: Dissection was started from the root of the neck. No surgical scars, gross anatomical and morphological abnormalities was noted on the cadaver. Measurements were taken during the anatomical dissections.  RESULTS: Of the 36 cadavers dissected in 34 (94.44%) cases phrenic nerve was found posterior to the subclavian vein and in 2(5.56%) cases found anterior to the subclavian vein of which one case was male and the other was female. In the male case in which phrenic nerve was passing anterior to the subclavian vein, it was adherent to the anterior wall of the subclavian vein and was nor piercing the vein wall. CONCLUSION: The cannulating needle may damage the phrenic nerve which is adherent to the subclavian vein. So, the puncture site should be more laterally at the outermost portion of the subclavian vein. Anatomical variants during invasive practical procedures should be always kept in mind. KEYWORDS: phrenic nerve, subclavian vein, phrenic nerve palsy, catheterization.

scholarly journals Third head of sternocleidomastoid muscle

2013 ◽  
Vol 02 (04) ◽  
pp. 218-220
Author(s):  
Anjali Satyen Sabnis ◽  
Shaguphta T Shaikh ◽  
Rakhi Milind More
Keyword(s):  
Clinical Significance ◽  
Gross Anatomy ◽  
Neck Region ◽  
Sternocleidomastoid Muscle ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Nerve Supply ◽  
Spinal Accessory ◽  
Important Landmark

AbstractDuring routine dissection in the neck region, a third head of sternocleidomastoid (SCM) muscle was found unilaterally in one cadaver and bilaterally in another cadaver. In both the cases third head was supplied by the spinal accessory nerve. SCM is most prominent muscle in the neck region which is used as important landmark during teaching living anatomy and gross anatomy of triangles of neck to students. As many important nerves and vessels are related to this key muscle of neck, any variation in relation to its origin, insertion and nerve supply attracts the attention of surgeons and anatomists. Embryological basis and clinical significance was discussed in these two cases of unilateral and bilateral presence of third head of SCM.

Combined expression of bcl-2, bcl-6, HIF, HGF, c-kit, neu/cerb2 and VEGF-C and their clinical significance in laryngeal squamous cell carcinoma

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 20079-20079
Author(s):  
I. O. Kara ◽  
A. Uguz ◽  
B. Sahin ◽  
E. Kilic-Bagir ◽  
M. Erkisi
Keyword(s):  
Clinical Significance ◽  
Squamous Cell ◽  
Tumor Grade ◽  
Squamous Cell Carcinomas ◽  
Regional Lymph Nodes ◽  
Formalin Fixed Paraffin ◽  
Formalin Fixed Paraffin Embedded ◽  
Postoperative Irradiation ◽  
Predicting Outcome ◽  
Formalin Fixed

20079 Background: Proteins regulating the cell cycle and cell death are frequently abnormally expressed in cancer. Several of these, particularly Bcl-2, Bcl-6, neu/cerb2 have been widely suggested as possible prognostic markers in diverse human malignancies. Their role in predicting outcome in squamous cell carcinomas of the head and neck is unclear. In addition c-kit protein has been shown in tumorogenesis. Because HNSCC preferentially metastasizes to regional lymph nodes, we investigated the expression of bcl-2, bcl-6, HIF, HGF, c-kit, neu/cerb2 and VEGF-C and their clinical significance in laryngeal squamous cell carcinomas by semiquantitative immunohistochemistry. Methods: We studied 115 patients with stage I o III tumors, all were treated with surgery ± postoperative irradiation/chemotherapy by a single institute. We studied the patients retrospectively to test the association between expression of Bcl-2, bcl-6, HIF, HGF, c-kit, neu/cerb2 and VEGF-C, as assessed by immunohistochemistry in formalin-fixed paraffin-embedded tissue and evaluated by two pathologist. We scored the expression of the proteins from negativ to severe expression. In addition we evaluated the degree of tumor grade, necrosis and also inflamation, respectively. Results: Within 115 patients we found severe expression of bcl-2 in 2 (1%), bcl-6 in 16 (13%), HIF in 57 (49%), HGF in 38 (33%), c-kit in 4 (3%), neu/cerb2 in 17 (14%) and VEGF-C in 11 (9%) patients, respectively. We found significant correlation between bcl-2 and necrosis (p = 0.003), HGF and inflamation (p = 0.05), c-kit and necrosis (p = 0.04), c-kit and tumor grade (p = 0.03) respectively. We found that the significant relation between bcl-6 and HIF (p = 0.000), bcl-6 and HGF (p = 0.02), bcl-6 and c-kit (p = 0.005), bcl-6 and VEGF-C (p = 0.000), HGF and VEGF-C (p = 0.005) respectively. Also we found that the significant correlation between tumor grade and HGF (p = 0.05). Conclusion: These data indicate that assessing expression of bcl-2 or bcl-6, c-kit and HGF is unlikely to be prognostically useful for surgically treated laryngeal carcinoma. No significant financial relationships to disclose.

The denticulate ligament: anatomy and functional significance

2001 ◽  
Vol 94 (2) ◽  
pp. 271-275 ◽  
Author(s):  
R. Shane Tubbs ◽  
George Salter ◽  
Paul A. Grabb ◽  
W. Jerry Oakes
Keyword(s):  
Spinal Cord ◽  
Functional Significance ◽  
Spinal Canal ◽  
Cervical Region ◽  
Content Type ◽  
Functional Studies ◽  
Applied Tension ◽  
Limited Degree ◽  
Formalin Fixed ◽  
Fine Print

Object. The authors conducted a study to examine the detailed anatomy of the denticulate ligaments and to assess their classic role in spinal cord stability within the spinal canal. Methods. Detailed observation of the denticulate ligaments in 12 adult cadavers was performed. Stress was applied in all major planes to discern when the ligaments would become taut, and at the same time, gross motion of the cord was observed at sites distal to the stresses applied. Tension necessary for avulsion of the ligaments in various areas of the spinal cord was also measured. Conclusions. These results show that the denticulate ligaments do not inhibit cord motion to such discrete areas of the cord as was once thought. The authors have determined that the ligaments are stronger in the cervical region and that they decrease in strength as the spinal cord descends. These findings are demonstrative of the denticulate ligaments being more resistant to caudal compared with cephalad stresses in the cord. Anterior and posterior motion is constrained by these ligaments but to a limited degree, especially as one descends inferiorly along the cord. Further embryological and functional studies of these ligaments is needed in non—formalin fixed tissues.

Phrenic nerve palsy caused by subclavian vein catheterization

1998 ◽  
Vol 13 (4) ◽  
pp. 1023-1025 ◽  
Author(s):  
I. Islek ◽  
T. Akpolat ◽  
M. Danaci
Keyword(s):  
Phrenic Nerve ◽  
Subclavian Vein ◽  
Nerve Palsy ◽  
Phrenic Nerve Palsy ◽  
Vein Catheterization
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