Abstract
Morphological features of ansa cervicalis and phrenic nerve were studied in 106 cadavers. Ansa cervicalis was located medial to the internal jugular vein in 63% (medial type) and lateral to the vein in 33.7% (lateral type). Ansa cervicalis was derived from a combination of C1-C4 spinal segments, with C1-C3 being the most frequent pattern (87.5%). In >60% the ansa was bilaterally symmetrical. The distribution of medial and lateral types was equal on left and right sides of the body. The segmental composition of the inferior root was higher in the medial type and also on the left side of the body. In the lateral type the branches that formed the inferior root frequently (75%) formed a common trunk before joining the superior root, but in 74.8% of the medial type they joined the superior root independently. The phrenic nerve was derived from C4 and C5 in 52%. The C4 segment was present in the phrenic nerve in all cases except one. Additional phrenic components that pass anterior to the subclavian vein were defined as accessory phrenic nerves and found in 28.7%, while those passing posterior to the same vein were defined as secondary phrenic nerves (19.8%). Most of the accessory phrenic nerves contained a C5 segment and the nerve to subclavius was the commonest source. Various relationships between the ansa cervicalis and the phrenic nerve are investigated and, based on these findings, two separate classifications for the two nerves are suggested.
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References
Bergman RA, Thompson SA, Afifi AK, Saadeh FA (1988) Compendium of Human Anatomic Variation. Urban and Schwarzenberg, Baltimore, Munich.
Caliot P, Dumont D (1983) Morphological study of the ansa cervicalis. Rev Laryngol Otol Rhinol (Bord) 104, 441–4 (in French).
Caliot P, Pinsolle J, Bousquet V (1983) Contribution to the study of the origin of the phrenic nerve (Nervus phrenicus). Apropos of 100 dissections of the cervical plexus. Bull Assoc Anat (Nancy) 67, 383–8 (in French).
Caliot P, Dumont D, Bousquet V, Midy D (1986) A note on the anastomoses between the hypoglossal nerve and the cervical plexus. Surg Radiol Anat 8, 75–9.
Chhetri DK, Berke GS (1997) Ansa cervicalis nerve: Review of the topographic anatomy and morphology. Laryngoscope 107, 1366–72.
Crumley RL, Izdebski K (1986) Voice quality following laryngeal reinnervation by ansa hypoglossi transfer. Laryngoscope 96, 611–16.
Frazier CH, Mosser WB (1926) Treatment of recurrent laryngeal nerve paralysis by nerve anastomosis. Surg Gynecol Obstet 43, 134–9.
Goto F, Goto M, Fujimoto T (1976) On a case of an extra-pericardial branch from the ansa cervicalis. Kaibogaku Zasshi 51, 104- 8 (in Japanese).
Grant JCB (1962) Grant’s Atlas of Anatomy. Williams & Wilkins, Baltimore.
Hall-Craggs ECB (1985) Anatomy as a Basis for Clinical Medicine. Urban & Schwarzenberg, Baltimore.
Indrasingh I, Abraham S, Vettivel S, Chandi G (1999) A rare vagal origin of the superior root of ansa cervicalis: A case report. J Anat Soc India 48, 6–8.
Kazama T (1961) Anatomical study of the cervical plexus of the Japanese. Koku Kaibo Kenkyu 19, 249–61 (in Japanese).
Kikuchi T (1970) A contribution to the morphology of the ansa cervicalis and the phrenic nerve. Acta Anat Nipon 45, 242–81.
Kukwa A, Marchel A, Pietniczka M, Rakowicz M, Krajewski R (1994) Reanimation of the face after facial nerve palsy resulting from resection of a cerebellopontine angle tumor. Br J Neurosurg 8, 327–32.
Last RJ (1984) Anatomy; Regional and Applied. Churchill Livingstone, Edinburgh.
Maruyama K (1944) Beitrag zur Ansa hypoglossi bei Japanischen Foten. Fol Anat Jap 22, 669–73.
Matsumura H, Kumaki K (1996) Morphogenesis of the subclavian vein relative to the course of the nerve to the subclavius muscle and the phrenic nerve. Acta Med Biol 44, 13–18.
Miyauchi A, Matsusaka K, Kihara M et al. (1998) The role of ansa to recurrent laryngeal nerve anastomosis in operations for thyroid cancer. Eur J Surg 164, 927–33.
Miyauchi A, Yokozawa T, Kobayashi K, Hirai K, Matsuzuka F, Kuma K (2001) Opposite ansa cervicalis to recurrent laryngeal nerve anastomosis to restore phonation in patients with advanced thyroid cancer. Eur J Surg 167, 540–1.
Moore KL (1992) Clinically Oriented Anatomy. Williams & Wilkins, Baltimore.
Olry R, Haines DE (2002) Ansa hypoglossi or Ansa cervicalis? That is the question. J Hist Neurosci 11, 302–4.
Poviraev NP, Chernikov YF (1967) Anatomy of the ansa cervicalis. Excerpt Med 21, 219.
Rath G, Anand C (1994) Vagocervical complex replacing an absent ansa cervicalis. Surg Radiol Anat 16, 441–3.
]Romanes GJ (1972) Cunningham’s Textbook of Anatomy. Oxford University Press, London.
Schipper J, Arndt S, Maier W, Spetzger U, Ridder GJ (2005) Paralyzed face. Ansa cervicalis nervi hypoglossi. Chirurg 76, 47–53 (in German).
Shvedavchenko AI (1998) Variants in the position of the ansa cervicalis in man. Morphologia 114, 47–9 (in Russian).
Singh I (1992) B.D.Chaurasia’s Human Anatomy; Regional and Applied, Vol. 3. CBS Publishers, Delhi.
Standring S (2005) Gray’s Anatomy: The Anatomical Basis of Clinical Practice. Elsevier Churchill Livingstone, London.
Steiner HH, Steiner-Milz HG, Kremer P, Hamer J, Albert FK, Kunze St (1997) The ansa cervicalis hypoglossal-facial nerve coaptation for indirect facial nerve repair. Clin Neurol Neurosurg 99 (Suppl. 1), S120.
Tanaka S, Zukeran C, Kuratani S, Ishikawa Y (1988) A case report of the anterior pericardial branch of the cervical ansa; a comparative anatomical and ontogenetical consideration. Anat Anz 165, 269–76.
Uematsu K (1928) Ueber den plexus hypoglossocervicalis des menschen. Acta School Med Kioto 10, 287–317 (in German).
Verma R, Das S, Suri R (2005) Unusual organization of the ansa cervicalis: A case report. Braz J Morphol Sci 22, 175–7.
Vilensky JA (2006) C3, C4, C5 keep you alive, or do they? Clin Anat 19, 130–1.
Vollala VR, Bhat SM, Nayak S et al. (2005) A rare origin of upper root of ansa cervicalis from vagus nerve: A case report. Neuroanatomy 4, 8–9.
Yamada M, Mannen H (1985) Anatomy for Dissectors. Nankodo, Tokyo (in Japanese).
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Banneheka, S. Morphological study of the ansa cervicalis and the phrenic nerve. Anato Sci Int 83, 31–44 (2008). https://doi.org/10.1111/j.1447-073X.2007.00201.x
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DOI: https://doi.org/10.1111/j.1447-073X.2007.00201.x