Intraoperative relationship of the spinal accessory nerve to the internal jugular vein: Variation from cadaver studies

Taylor, Christine B.; Boone, John L.; Schmalbach, Cecelia E.; Miller, Frank R.

doi:10.1016/j.amjoto.2013.05.008

Cited by 29 publications

(18 citation statements)

References 8 publications

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“…In their in vivo study, Hinsley and Hartig (4) found that the SAN pierced the IJV in <1% of cases (one in 116). A similar incidence is reported in cadaveric studies by Taylor et al (5) in 2013 (5) (two of 207 cases) and Saman et al (3) in 2011 (one of 67 cases). While this anatomical variation is of a great academic interest, it does not appear to cause any functional issues in itself, unless interventional procedures, such as femoral cannulation, are required.…”

Section: Multiple Concomitant Anatomical Variants Challenging Synchrosupporting

confidence: 83%

Multiple Concomitant Anatomical Variants Challenging Synchronous Neck and Axillary Lymphadenectomy and Latissimus Dorsi Flap Reconstruction in a Patient with Malignant Melanoma

Pikturnaite

Wright

Josty

2015

Plastic Surgery Case Studies

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K nowledge of human anatomy acquired at the university level carries surgeons through most of their careers. However, it is important to be aware of uncommon anatomical variants when performing surgery. We describe a case of three anatomical variants found in three different anatomical locations in a single patient during one operative episode. These include Langer's muscle (axillopectoral/axillary arch), transjugular course of the spinal accessory nerve (SAN) and unusual layout of the femoral vessels at the inguinal ligament. Multiple anomalies in a single anatomical unit, such as the upper limb, are well described and include various combinations of axillopectoral muscle with presence of a third head of biceps brachii, Gantzer's muscle, accessory or abnormal divisions of forearm flexors, unusual muscular innervation (1) and many others. However, multiple variations encountered during a single operative episode in several anatomical parts of the body are uncommon. CAsE prEsEnTATIon A 74-year-old woman presented with a 10 cm locally advanced polypoid nodular ulcerated malignant melanoma with Breslow thickness of 35 mm and Clark's level V.

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Section: Multiple Concomitant Anatomical Variants Challenging Synchrosupporting

confidence: 83%

Multiple Concomitant Anatomical Variants Challenging Synchronous Neck and Axillary Lymphadenectomy and Latissimus Dorsi Flap Reconstruction in a Patient with Malignant Melanoma

Pikturnaite

Wright

Josty

2015

Plastic Surgery Case Studies

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“…The SAN in the Kenyan population was also noted to maintain a more frequent medial relation to the IJV as compared with the data derived from Australia and the United States of America where the nerve was predominantly on the lateral side 6,7,13 (►Table 3). This variation is important when carrying out node biopsies, since the nerve, being more medial, would make its identification difficult as compared with if it were located lateral to the IJV.…”

Section: Discussionmentioning

confidence: 59%

“…The anatomy of the extracranial SAN displays variations in its relation to the SCM and IJV as well as in its point of entry into the posterior triangle of the neck 345678. Data collected from France, the United States of America, and the United Kingdom showed that the SAN perforates the SCM in the majority of their populations and enters the posterior triangle of the neck at a point 4 to 6.7 cm as measured from the MT.…”

mentioning

confidence: 99%

The Relation of the Extracranial Spinal Accessory Nerve to the Sternocleidomastoid Muscle and the Internal Jugular Vein

Amuti

Butt

Otieno

et al. 2019

Craniomaxillofacial Trauma & Reconstruction

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The spinal accessory nerve (SAN) exhibits variant anatomy in its relation to the internal jugular vein (IJV) as well as the sternocleidomastoid muscle (SCM). These variations are important in locating the nerve during surgical neck procedures to avoid its inadvertent injury. These variations, however, are not conserved among different populations and data from the Kenyan setting are partly elucidated. This study, therefore, aims to determine the variant anatomical relationship of the SAN to the SCM and IJV in a select Kenyan population. Forty cadaveric necks were studied bilaterally during routine dissection and the data collected were analyzed using SPSS version 21. Means and modes were calculated for the point of entry of the SAN into the posterior triangle of the neck as well as for its relation to the SCM. Side variations for both of these were analyzed using Student's t-test. Data relating the SAN to the IJV were represented in percentages and side variations were analyzed using the chi-square test. The SAN point of entry into the posterior triangle of the neck was 5.38 cm (3.501–8.008 cm) on the left side and 5.637 cm (3.504–9.173 cm) on the right side ( p = 0.785) from the mastoid process. The nerve perforated the SCM in four cases (10%) on the left side and in eight cases (20%) on the right ( p = 0.253). The SAN lay predominantly medial to the IJV on both sides of the neck, 87.5% on the left side of the neck versus 82.5% on the right ( p = 0.831). In conclusion, the variant relation of the SAN to the IJV and SCM as observed in this setting is an important consideration during radical neck procedures and node biopsies.

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“…As previously described, the accessory nerve most commonly traverses lateral to the IJV. However, it can less commonly travel medial to the IJV, through the IJV, or even divide and come back together to travel both medial and lateral to the IJV (Saman et al, ; Hashimoto et al, ; Taylor et al, ). In rare cases, the SCM muscle can serve as the nerve's terminus with the trapezius being exclusively innervated by cervical nerve fibers.…”

Section: Variationsmentioning

confidence: 99%

The Accessory Nerve: A Comprehensive Review of its Anatomy, Development, Variations, Landmarks and Clinical Considerations

Johal

Iwanaga

Tubbs

et al. 2018

The Anatomical Record

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The accessory nerve continues to be a topic of much discussion regarding its exact function and in particular to its cranial roots. Recently, various surgical procedures have been devised that repurpose the accessory nerve (e.g., lengthening procedures, contralateral neurotization procedures). Currently, we continue to learn and have much to learn about this lower cranial nerve. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc.

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Intraoperative relationship of the spinal accessory nerve to the internal jugular vein: Variation from cadaver studies

Cited by 29 publications

References 8 publications

Multiple Concomitant Anatomical Variants Challenging Synchronous Neck and Axillary Lymphadenectomy and Latissimus Dorsi Flap Reconstruction in a Patient with Malignant Melanoma

Multiple Concomitant Anatomical Variants Challenging Synchronous Neck and Axillary Lymphadenectomy and Latissimus Dorsi Flap Reconstruction in a Patient with Malignant Melanoma

The Relation of the Extracranial Spinal Accessory Nerve to the Sternocleidomastoid Muscle and the Internal Jugular Vein

The Accessory Nerve: A Comprehensive Review of its Anatomy, Development, Variations, Landmarks and Clinical Considerations

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