Skip to main content
SpringerLink
Log in

The course of lower cranial nerves within the neck: a cadaveric dissection study

  • Head & Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the course of lower cranial nerves (CNs) within the neck in relation to surrounding structures and anatomic landmarks via a cadaveric dissection study.

Methods

A total of 70 neck dissections (31 bilateral, 8 unilateral) were performed on 39 adult fresh cadavers [mean (SD) age: 38.5 (11.2) years, 29 male, 10 female] to identify the course of lower CNs [spinal accessory nerve (SAN), vagus nerve and hypoglossal nerve] within the neck in relation to surrounding structures [internal jugular vein (IJV), common carotid artery (CCA)] and distance to anatomical landmarks (cricoid cartilage, hyoid bone, digastric muscle).

Results

SAN travelled most commonly anterior to IJV (51.4%) at the level of jugular foramen, while travelling lateral to IJV at the post belly of digastric (55.7%) and inferior to digastric muscle (90%) in most neck dissections. Vagus nerve travelled lateral to CCA in majority (94.3%) of dissections, while medial (2.9%), posterolateral (1.4%) and posterior (1.4%) positions were also noted. Average distance of hypoglossal nerve was 27.7 (9.7) mm to carotid bifurcation, 9.3 (3.9) mm to hyoid bone, and 54.7 (18.0) mm to the inferior border of cricoid cartilage.

Conclusion

In conclusion, our findings indicate that anatomic variations are not rare in the course of lower CNs within the neck in relation to adjacent structures, and awareness of these variations together with knowledge of distance to certain anatomic landmarks may help the surgeon to identify lower CNs during neck surgery and prevent potential nerve injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Boström D, Dahlin LB (2007) Iatrogenic injury to the accessory nerve. Scand J Plast Reconstr Surg Hand Surg 41:82–87

    Article  PubMed  Google Scholar 

  2. Skinner SA (2011) Neurophysiologic monitoring of the spinal accessory nerve, hypoglossal nerve, and the spinomedullary region. J Clin Neurophysiol 28:587–598

    Article  PubMed  Google Scholar 

  3. Popovski V, Benedetti A, Popovic-Monevska D, Pacnevski G, Iliev A, Stamatoski A, Zhivadinovik J (2015) Еffectiveness of spinal accessory nerve preservation in modified neck dissections. RJPBCS 6:1184–1191

    CAS  Google Scholar 

  4. Aramrattana A, Sittitrai P, Harnsiriwattanagit K (2005) Surgical anatomy of the spinal accessory nerve in the posterior triangle of the neck. Asian J Surg 28:171–173

    Article  PubMed  Google Scholar 

  5. Brandenburg JH, Lee CYS (1981) The eleventh nerve in radical neck surgery. Laryngoscope 91:1851–1859

    Article  PubMed  CAS  Google Scholar 

  6. Nason RW, Abdulrauf BM, Stranc MF (2000) The anatomy of the accessory nerve and cervical lymph node biopsy. Am J Surg 180:241–243

    Article  PubMed  CAS  Google Scholar 

  7. Watkins JP, Williams GB, Mascioli AA, Wan JY, Samant S (2011) Shoulder function in patients undergoing selective neck dissection with or without radiation and chemotherapy. Head Neck 33:615–619

    Article  PubMed  Google Scholar 

  8. Hinsley ML, Hartig GK (2010) Anatomic relationship between the spinal accessory nerve and internal jugular vein in the upper neck. Otolaryngol Head Neck Surg 143:239–241

    Article  PubMed  Google Scholar 

  9. Cunningham EJ, Bond R, Mayberg MR, Warlow CP, Rothwell PM (2004) Risk of persistent cranial nerve injury after carotid endarterectomy. J Neurosurg 101:445–448

    Article  PubMed  Google Scholar 

  10. Meng S, Reissig LF, Tzou CH, Meng K, Grisold W, Weninger W (2016) Ultrasound of the hypoglossal nerve in the neck: visualization and initial clinical experience with patients. AJNR Am J Neuroradiol 37:354–359

    Article  PubMed  CAS  Google Scholar 

  11. Mahadevappa K, Chacko T, Nair AK (2012) Isolated unilateral hypoglossal nerve palsy due to vertebral artery dissection. Clin Med Res 10:127–130

    Article  PubMed  PubMed Central  Google Scholar 

  12. Junquera L, Gallego L (2012) Images in clinical medicine: denervation atrophy of the tongue after hypoglossal-nerve injury. N Engl J Med 367:156

    Article  PubMed  CAS  Google Scholar 

  13. Keane JR (1996) Twelfth-nerve palsy: analysis of 100 cases. Arch Neurol 53:561–566

    Article  PubMed  CAS  Google Scholar 

  14. Saki N, Nikakhlagh S (2012) Complications of neck dissection. In: Kummoona R (ed) Neck dissection—clinical application and recent advances. InTech, ISBN: 978-953-51-0104-8. http://www.intechopen.com/books/neck-dissection-clinical-application-and-recent-advances/complicationof-neck-dissection. https://doi.org/10.5772/32638

  15. Lo A, Oehley M, Bartlett A, Adams D, Blyth P, Al-Ali S (2006) Anatomical variations of the common carotid artery bifurcation. ANZ J Surg 76:970–972

    Article  PubMed  Google Scholar 

  16. Chaukar DA, Pai A, D’Cruz AK (2006) A technique to identify and preserve the spinal accessory nerve during neck dissection. J Laryngol Otol 120:494–496

    Article  PubMed  CAS  Google Scholar 

  17. Saman M, Etebari P, Pakdaman MN, Urken ML (2011) Anatomic relationship between the spinal accessory nerve and the jugular vein: a cadaveric study. Surg Radiol Anat 33:175–179

    Article  PubMed  CAS  Google Scholar 

  18. Lucev N, Bobinac D, Maric I, Drescik I (2000) Variations of the great arteries in the carotid triangle. Otolaryngol Head Neck Surg 122:590–591

    PubMed  CAS  Google Scholar 

  19. Overland J, Hodge JC, Breik O, Krishnan S (2016) Surgical anatomy of the spinal accessory nerve: review of the literature and case report of a rare anatomical variant. J Laryngol Otol 130:969–972

    Article  PubMed  CAS  Google Scholar 

  20. Taylor CB, Boone JL, Schmalbach CE, Miller FR (2013) Intraoperative relationship of the spinal accessory nerve to the internal jugular vein: variation from cadaver studies. Am J Otolaryngol 34:527–529

    Article  PubMed  Google Scholar 

  21. Kierner AC, Zelenka I, Heller S, Burian M (2000) Surgical anatomy of the spinal accessory nerve and the trapezius branches of the cervical plexus. Arch Surg 135:1428–1431

    Article  PubMed  CAS  Google Scholar 

  22. Lee SH, Lee JK, Jin SM, Kim JH, Park IS, Chu HR, Ahn HY, Rho YS (2009) Anatomic variations of the spinal accessory nerve and its relevance to level IIb lymph nodes. Otolaryngol Head Neck Surg 141:639–644

    Article  PubMed  Google Scholar 

  23. Cappiello J, Piazza C, Nicolai P (2007) The spinal accessory nerve in head and neck surgery. Curr Opin Otolaryngol Head Neck Surg 15:107–111

    Article  PubMed  Google Scholar 

  24. Assadian A, Senekowitsch C, Pfaffelmeyer N, Assadian O, Ptakovsky H, Hagmuller GW (2004) Incidence of cranial nerve injuries after carotid eversion endarterectomy with a transverse skin incision under regional anaesthesia. Eur J Vasc Endovasc Surg 28:421–424

    Article  PubMed  CAS  Google Scholar 

Download references

Funding

None.

Author information

Author notes

  1. Enes Yigit

    Present address: Department of E.N.T., Luleburgaz State Hospital, Istiklal Mahallesi, Istanbul Caddesi No:174, Luleburgaz, Kirklareli, Turkey

Authors and Affiliations

  1. Department of Otorhinolaryngology, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey

    Enes Yigit, Engin Dursun, Suat Terzi, Zerrin Ozergin Coskun & Munir Demirci

  2. Mortuary Department, The Ministry of Justice’s Council of Forensic Medicine, Istanbul, Turkey

    Elif Omeroglu

  3. Department of Otolaryngology Head and Neck Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey

    Ahmet Volkan Sunter

  4. Department of Otolaryngology Head and Neck Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey

    Deniz Tuna Edizer

Authors
  1. Enes Yigit
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Engin Dursun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elif Omeroglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahmet Volkan Sunter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Deniz Tuna Edizer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Suat Terzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zerrin Ozergin Coskun
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Munir Demirci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Enes Yigit.

Ethics declarations

Conflict of interest

Authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the institutional ethics committee of Istanbul Forensic Medicine Institution (date of approval: 17/02/2015, Reference number/Protocol No: 21589509/18355/18).

Informed consent

N/A (a cadaveric dissection study).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yigit, E., Dursun, E., Omeroglu, E. et al. The course of lower cranial nerves within the neck: a cadaveric dissection study. Eur Arch Otorhinolaryngol 275, 2541–2548 (2018). https://doi.org/10.1007/s00405-018-5091-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-018-5091-4

Keywords

Search

Navigation