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Identification of three anatomical patterns of the spinal accessory nerve in the neck by neurophysiological mapping.

Lanisnik B, Zargi M, Rodi Z - Radiol Oncol (2014)

Bottom Line: In type 2 the nerve for trapezius muscle branches off before entering the SCm (22%).The nerve than exits this junction more medially as a single trapezius branch.The description of three anatomical patterns in level II and V could help preserving the trapezius branch during MRND.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Center Maribor, Slovenia.

ABSTRACT

Background: In spite of preservation of the accessory nerve there is still considerable proportion of patients with partial nerve damage during modified radical neck dissection (MRND).

Methods: The nerve was identified during the surgery and its branches for the trapezius muscle mapped with nerve monitor.

Results: The accessory nerve was mapped during 74 hemineck dissections and three patterns were identified. In type 1 nerve exits at the posterior end of the sternocleidomastoid muscle (SCm) and then it enters the level V (66%). In type 2 the nerve for trapezius muscle branches off before entering the SCm (22%). In type 3 the nerve exits at the posterior part of the SCm and it joins to the cervical plexus (12%). The nerve than exits this junction more medially as a single trapezius branch.

Conclusions: The description of three anatomical patterns in level II and V could help preserving the trapezius branch during MRND.

No MeSH data available.


Related in: MedlinePlus

Type 3 pattern is more complicated. The trapezius branch is seen exiting at the posterior margin of the sternocleidomastoid muscle and joining with cervical nerves. From this junction, a single branch exits more medially and enters level V (branch is looped with suture). If this type is not recognized, the branch that enters level V might be mistaken for a cervical nerve and cut. This pattern was present in 11% of all patients. SCM-sternocleidomastoid muscle
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f4-rado-48-04-387: Type 3 pattern is more complicated. The trapezius branch is seen exiting at the posterior margin of the sternocleidomastoid muscle and joining with cervical nerves. From this junction, a single branch exits more medially and enters level V (branch is looped with suture). If this type is not recognized, the branch that enters level V might be mistaken for a cervical nerve and cut. This pattern was present in 11% of all patients. SCM-sternocleidomastoid muscle

Mentions: Type 3 is the least common and was found in 9 out of 74 heminecks (12%). It is the most complicated pattern, where the trapezius branch exited at the posterior end of the sternocleidomastoid muscle and joined to the cervical roots at level C3 and/or C4. The trapezius branch then exited from this junction more medially and then it turned deep to the level V (Figure 4).


Identification of three anatomical patterns of the spinal accessory nerve in the neck by neurophysiological mapping.

Lanisnik B, Zargi M, Rodi Z - Radiol Oncol (2014)

Type 3 pattern is more complicated. The trapezius branch is seen exiting at the posterior margin of the sternocleidomastoid muscle and joining with cervical nerves. From this junction, a single branch exits more medially and enters level V (branch is looped with suture). If this type is not recognized, the branch that enters level V might be mistaken for a cervical nerve and cut. This pattern was present in 11% of all patients. SCM-sternocleidomastoid muscle
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230559&req=5

f4-rado-48-04-387: Type 3 pattern is more complicated. The trapezius branch is seen exiting at the posterior margin of the sternocleidomastoid muscle and joining with cervical nerves. From this junction, a single branch exits more medially and enters level V (branch is looped with suture). If this type is not recognized, the branch that enters level V might be mistaken for a cervical nerve and cut. This pattern was present in 11% of all patients. SCM-sternocleidomastoid muscle
Mentions: Type 3 is the least common and was found in 9 out of 74 heminecks (12%). It is the most complicated pattern, where the trapezius branch exited at the posterior end of the sternocleidomastoid muscle and joined to the cervical roots at level C3 and/or C4. The trapezius branch then exited from this junction more medially and then it turned deep to the level V (Figure 4).

Bottom Line: In type 2 the nerve for trapezius muscle branches off before entering the SCm (22%).The nerve than exits this junction more medially as a single trapezius branch.The description of three anatomical patterns in level II and V could help preserving the trapezius branch during MRND.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Center Maribor, Slovenia.

ABSTRACT

Background: In spite of preservation of the accessory nerve there is still considerable proportion of patients with partial nerve damage during modified radical neck dissection (MRND).

Methods: The nerve was identified during the surgery and its branches for the trapezius muscle mapped with nerve monitor.

Results: The accessory nerve was mapped during 74 hemineck dissections and three patterns were identified. In type 1 nerve exits at the posterior end of the sternocleidomastoid muscle (SCm) and then it enters the level V (66%). In type 2 the nerve for trapezius muscle branches off before entering the SCm (22%). In type 3 the nerve exits at the posterior part of the SCm and it joins to the cervical plexus (12%). The nerve than exits this junction more medially as a single trapezius branch.

Conclusions: The description of three anatomical patterns in level II and V could help preserving the trapezius branch during MRND.

No MeSH data available.


Related in: MedlinePlus