Anatomy of the accessory nerve and its cervical contributions in the neck

Soo, Khee‐Chee; Hamlyn, Peter J.; Pegington, John; Westbury, G

doi:10.1002/hed.2890090207

Cited by 117 publications

(94 citation statements)

References 6 publications

(3 reference statements)

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“…In a recent study, this communication was found in 22 neck dissections (11 cadavers) and most of them were observed at the inferior border of submandibular gland (Domet et al, 2005). Communications between the cervical plexus and spinal accessory nerve are also well known and have been reported in the past (Soo et al, 1986;Kierner et al, 2000). Branches of cervical plexus rarely communicate with phrenic nerve (Loukas et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

Communication of the Anterior Branch of the Great Auricular Nerve with the Cervical Branch of Facial Nerve and its Variant Nerve Endings Deep in the Parotid Gland

et al. 2012

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SUMMARY:The communications between the branches of cervical plexus and cervical branch of facial nerve are common and are well known. However, this communication usually occurs between the transverse cervical nerve and cervical branch of facial nerve. During routine dissection classes for the Medical undergraduate students, we came across an anatomical variant of anterior division of great auricular nerve. This variation was found in a 60-year-old male cadaver of South Indian origin and it was unilateral. The great auricular nerve arose from the loop of ventral rami of C2 and C3 spinal nerves and divided into anterior and posterior branches. The anterior branch ran obliquely upwards and forwards on the surface of the sternocleidomastoid muscle along with the external jugular vein towards the apex of parotid gland and divided into many branches. One of these branches gave a communicating branch to cervical branch of facial nerve outside the parotid gland. Nerve endings of the remaining branches were found to penetrate the interlobular septa and a few of them were seen deep in the gland along the ducts and near the vessels. The functional significance of anatomic variations of nerve endings in relation to ducts, thin vessels deep in the parotid gland, observed in the present case are yet to be evaluated.

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Section: Discussionmentioning

confidence: 99%

Communication of the Anterior Branch of the Great Auricular Nerve with the Cervical Branch of Facial Nerve and its Variant Nerve Endings Deep in the Parotid Gland

et al. 2012

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“…Contributions from cervical nerve 2-4 also may provide additional protection against extrinsic damage. 21 Some authors have speculated about other mechanisms, such as direct nerve damage and vascular sclerosis, but their role in radiation cranial nerve palsy awaits further study.…”

Section: Discussionmentioning

confidence: 99%

Radiation‐related cranial nerve palsy in patients with nasopharyngeal carcinoma

Lin

Jen

Lin

2002

Cancer

144

104

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BACKGROUNDCranial nerve palsy is a rare complication after patients with nasopharyngeal carcinoma (NPC) receive radiotherapy using a technique that delivers 180–200 centigrays (cGy) per day. Cranial neuropathy is of particular clinical interest in terms of making a differential diagnosis, because it is also a common presenting manifestation in patients with NPC. Cranial neuropathy may lead to distressing signs and symptoms in these patients, and their treatment has not been addressed in previous reports. This article presents the authors' experience with radiotherapy‐related cranial nerve palsy in patients with NPC.METHODSNineteen patients were diagnosed with radiation‐related neuropathy. Patients with recurrent tumors or with a suspicion of persistent or recurrent tumors were excluded. Most patients were treated using 180 cGy or 200 cGy per fraction per day. The total dose was 7000–13,000 cGy to the nasopharynx and 5000–9000 cGy to the neck. Unilateral vocal cord paralysis alone and hearing loss were not included in the analysis.RESULTSThere were 15 male patients and 4 female patients. The latency before palsy occurred was 12–240 months. Single nerve palsy developed in four patients, including two patients with hypoglossal palsy and two patients with recurrent laryngeal palsy. Two patients had three nerve palsies each. The other 13 patients presented with 2 nerve palsies each. Vagus and hypoglossal palsy appeared to be a frequent combination and occurred in 11 patients. Overall, there were 17 patients with hypoglossal palsy (7 bilateral, 8 left‐sided, and 2 right‐sided), 11 patients with vagus palsy (2 bilateral, 7 left‐sided, and 2 right‐sided), 6 patients with recurrent laryngeal nerve palsy (5 bilateral), and 2 patients with accessory palsies (all bilateral). Marked neck fibrosis was present in 12 patients. Patients who had vocal cord paralysis suffered from easy choking and hoarseness. Severe respiratory difficulty occurred in two patients who had bilateral vocal cord palsy. Surgical procedures included laryngoplasty, tracheostomy, and gastrostomy. Quality of life improved considerably after patients underwent surgery.CONCLUSIONSRadiotherapy‐related cranial nerve palsy may occur in patients with NPC after they receive conventional radiotherapy. Hypoglossal nerve palsy was found the most frequently in this series, followed by vagus nerve palsy and recurrent laryngeal nerve palsy. Neck fibrosis and the course of the three nerves through the neck may be important risk factors for the development of palsy. The diagnosis must be made only after the possibilities of tumor‐induced palsy and idiopathic palsy are excluded. Surgery is helpful in improving the quality of life in many patients. Cancer 2002;95:404–9. © 2002 American Cancer Society.DOI 10.1002/cncr.10668

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“…In all the reported cases, SAN received these contributions deep in the SM [8,9]. For the first time, we are reporting the presence of communicating branch in the posterior triangle.…”

Section: Introductionmentioning

confidence: 74%

“…Most of these contributions come from the C2, both C2 and C3, or C3 spinal nerves [8]. In a study, Lee et al, [9] found the contributions from C2 in 53.1% cases; from C2 and C3 in 38.1% cases and anatomy Section…”

Section: Discussionmentioning

confidence: 97%