Abstract
Iatrogenic injury to the spinal accessory nerve has been widely documented and can have medico-legal implications. The resulting syndrome of pain, paralysis and winging of the scapula are often the source of considerable morbidity. This paper researches the degree of accuracy achievable in mapping the surface anatomy of the spinal accessory nerve in the region of the posterior triangle with a view to creating a cartographical aid to surgical procedures. The necks of 25 adult cadavers were dissected bilaterally to expose the spinal accessory nerve. Variations in the course and distribution of the spinal accessory nerve in the posterior triangle were recorded along with its relationship to the borders of sternocleidomastoid and trapezius. Considerable variation was seen in the surface and regional anatomy of the nerve and in the contribution of the cervical plexus to the spinal accessory nerve in the posterior triangle. Measurements of the running course and exit point of the nerve into and from the posterior triangle differed significantly from those previously recorded. Delineation of an accurate surface anatomy was not possible. Creating a map to define the surface anatomy of the spinal accessory nerve in the posterior triangle is an unrealistic goal given its wide variations in man. Avoidance of damage to the spinal accessory nerve cannot be achieved by slavishly adhering to surface markings given in textbooks, but only by cautious dissection during operations on the posterior triangle.
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References
Andersen PE, Shah JP, Cambronero E, Spiro RH (1994) The role of comprehensive neck dissection with preservation of the spinal accessory nerve in the clinically positive neck. Am J Surg 168:499–502
Aziz NH, Shakespeare DT (1989) Blunt injury to the spinal accessory nerve. Injury 20:381–382
Battista AF (1991) Complications of biopsy of the cervical lymph node. Surg Gynecol Obstet 173:142–146
Berry H, MacDonald EA, Mrazek AC (1991) Accessory nerve palsy: a review of 23 cases. Can J Neurol Sci 18:337–341
Brown H, Burns S, Kaiser CW (1988) The spinal accessory nerve plexus, the trapezius muscle, and shoulder stabilisation after radical neck cancer surgery. Ann Surg 208:654–661
Brown H, Hidden G, Ledroux M, Poitevan L (2000) Anatomy and blood supply of the lower four cranial and cervical nerves: relevance to surgical neck dissection. Proc Soc Exp Biol Med 223:352–361
Brown H (2002) Anatomy of the spinal accessory nerve plexus: relevance to head and neck cancer and atherosclerosis. Exp Biol Med 227:570–578
Caliot Ph, Cabanie P, Bousquet V, Midy D (1984) A contribution to the study of the innervation of the sternocleidomastoid muscle. Anat Clin 6:21–28
Caliot Ph, Bousquet V, Midy D, Cabanie P (1989) A contribution to the study of the accessory nerve: surgical implications. Surg Radiol Anat 11:11–15
Diop EM, Sow ML, Diop LS, Sylla S (1987) Anatomical features concerning the spinal accessory nerve. Apropos of 106 dissections of the neck in cadavers. Ann Otolaryngol Chir Cervicofac 104:227–232
Donner TR, Kline DG (1993) Extracranial spinal accessory nerve injury. Neurosurgery 32:907–910
Ewing MR, Martin H (1952) Disability following radical neck dissection; an assessment based on the postoperative evaluation of 100 patients. Cancer 5:873–883
Fitzgerald MJ, Comerford PT, Tuffery AR (1982) Sources of innervation of the neuromuscular spindles in the sternomastoid and trapezius. J Anat 134:471–490
Gordon SL, Graham WP, Black JT, Miller SH (1977) Accessory nerve function after surgical procedures in the posterior triangle. Arch Surg 112:264–268
Hanford JM (1933) Surgical excision of tuberculous lymph nodes of the neck. A report on one hundred and thirty one patients with follow up results. Surg Clin North Am 13:301–310
Kaji T, Aizawa S, Uemura M, Yasui K (2001) Establishment of the left right asymmetric innervation in the lancelot oral region. J Comp Neurol 435:394–405
King RJ, Motta G (1983) Iatrogenic spinal accessory nerve palsy. Ann R Coll Surg Engl 65:35–37
Krause HR, Bremerich A, Herrmann M (1991) The innervation of the trapezius muscle in connection with radical neck dissection—an anatomical study. J Craniomaxillofac Surg 19:87–89
Moore KL (1992) Clinically oriented anatomy, 3rd edn. Lippincott Williams & Wilkins, Philadelphia
Norden A (1960) Peripheral injuries to the spinal accessory nerve. Acta Chir Scand 94:515–532
Olarte M, Adams D (1977) Accessory nerve palsy. J Neurol Neurosurg Psychiatr 40:1113–1116
Paljarvi L, Partanen J (1980) Biting palsy of the accessory nerve. J Neurol Neurosurg Psychiatr 43:744–746
Romanes GJ, Cunningham DJ (1981) Cunningham’s textbook of anatomy, 12th edn. Oxford University Press, Oxford, pp 764
Shone GR, Yardely MPJ (1991) An audit into the incidence of handicap after unilateral radical neck dissection. J Laryngol Otol 105:760–762
Soo K-C, Hamlyn PJ, Pegington J, Westbury G (1986) Anatomy of the accessory nerve and its cervical contributions in the neck. Head Neck Surg 9:111–115
Soo KC, Guiloff RJ, Oh A, Della Rovere GQ, Westbury G (1990) Innervation of the trapezius muscle: a study in patients undergoing neck dissection. Head Neck 12:488–495
William’s PL, Warwick R, Dyson M, Bannister LH (1996) Gray’s Anatomy, 38th edn. Churchill Livingstone, London, pp 1255
Williams WW, Twyman RS, Donell ST, Birch R (1996) The posterior triangle and the painful shoulder: spinal accessory nerve injury. Ann R Coll Surg Engl 78:521–525
Wulff HB (1941) The treatment of tuberculous cervical lymphoma: late results in 230 cases treated partly surgically, partly radiologically. Acta Chir Scand 84:343–366
Younossi-Hartenstein A, Jones M, Hartenstein V (2001) Embryonic development of the nervous system of the temnocephalad flatworm Craspedella pedum. J Comp Neurol 435:259–262
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No grant was received in support of this work. This project complied with laws in the United Kingdom governing use of cadavers in research.
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Symes, A., Ellis, H. Variations in the surface anatomy of the spinal accessory nerve in the posterior triangle. Surg Radiol Anat 27, 404–408 (2005). https://doi.org/10.1007/s00276-005-0004-9
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DOI: https://doi.org/10.1007/s00276-005-0004-9