Anatomical variations of the spinal accessory nerve and its relevance to level IIb lymph nodes

2009 ◽  
Vol 141 (5) ◽  
pp. 639-644 ◽  
Author(s):  
Sang Hyuk Lee ◽  
Jong Kyu Lee ◽  
Sung Min Jin ◽  
Jin Hwan Kim ◽  
Il Seok Park ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Case Series ◽  
Anatomical Variations ◽  
Ventral Side ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Cervical Plexus ◽  
Spinal Accessory ◽  
Adjacent Structures ◽  
Inferior Border

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.

Nerve Graft Length and Recovery of Elbow Flexion Muscle Strength in Patients With Traumatic Brachial Plexus Injuries: Case Series

2021 ◽  
Author(s):  
Mariano Socolovsky ◽  
Gilda di Masi ◽  
Gonzalo Bonilla ◽  
Ana Lovaglio ◽  
Kartik G Krishnan
Keyword(s):  
Brachial Plexus ◽  
Case Series ◽  
Target Function ◽  
Elbow Flexion ◽  
Nerve Graft ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Nerve Reconstruction ◽  
Muscle Recovery ◽  
Spinal Accessory

Abstract BACKGROUND Traumatic brachial plexus injuries cause long-term maiming of patients. The major target function to restore in complex brachial plexus injury is elbow flexion. OBJECTIVE To retrospectively analyze the correlation between the length of the nerve graft and the strength of target muscle recovery in extraplexual and intraplexual nerve transfers. METHODS A total of 51 patients with complete or near-complete brachial plexus injuries were treated with a combination of nerve reconstruction strategies. The phrenic nerve (PN) was used as axon donor in 40 patients and the spinal accessory nerve was used in 11 patients. The recipient nerves were the anterior division of the upper trunk (AD), the musculocutaneous nerve (MC), or the biceps branches of the MC (BBs). An index comparing the strength of elbow flexion between the affected and the healthy arms was correlated with the choice of target nerve recipient and the length of nerve grafts, among other parameters. The mean follow-up was 4 yr. RESULTS Neither the choice of MC or BB as a recipient nor the length of the nerve graft showed a strong correlation with the strength of elbow flexion. The choice of very proximal recipient nerve (AD) led to axonal misrouting in 25% of the patients in whom no graft was employed. CONCLUSION The length of the nerve graft is not a negative factor for obtaining good muscle recovery for elbow flexion when using PN or spinal accessory nerve as axon donors in traumatic brachial plexus injuries.

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.

scholarly journals Spinal Accessory Nerve Duplication – A Rare Anatomical Consternation During Neck Dissectio

2021 ◽  
Vol 6 (4) ◽  
pp. 539-541
Author(s):  
Rohit Jindal ◽  
Kamal Kishor Lakhera ◽  
Pinakin Patel ◽  
Suresh Singh ◽  
Ravinder Singh Gothwal ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Anatomical Variations ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Clinical Implications ◽  
Spinal Accessory ◽  
Comprehensive Knowledge ◽  
Anatomical Knowledge ◽  
Shoulder Syndrome ◽  
Functional Neck Dissection

Prevention of the spinal accessory nerve (SAN) is an indispensable aspect of the functional neck dissection surgery to avoid highly disabling shoulder syndrome postoperatively. This requires comprehensive knowledge of the anatomy of SAN and its variations. Rare anatomical variations like SAN duplication can result in an inadvertant injury to the SAN. We report a case of duplication of SAN, which was encountered while doing a functional neck dissection surgery for oral squamous cell carcinoma. No iatrogenic injury occurred during the surgery and neither there was any SAN dysfunction post-operatively. Meticulous dissection and consistent identification of SAN, along with vast anatomical knowledge is the key to the preservation of the nerve during the surgery. This report aims to broaden our anatomical knowledge of SAN and also discuss the clinical implications and literature pertaining to the duplication of SAN.

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.

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