-
Brazilian Journal of Otorhinolaryngology 2020The anatomical complexity of the jugular foramen makes surgical procedures in this region delicate and difficult. Due to the advances in surgical techniques, approaches...
INTRODUCTION
The anatomical complexity of the jugular foramen makes surgical procedures in this region delicate and difficult. Due to the advances in surgical techniques, approaches to the jugular foramen became more frequent, requiring improvement of the knowledge of this region anatomy.
OBJECTIVE
To study the anatomy of the jugular foramen, internal jugular vein and glossopharyngeal, vagus and accessory nerves, and to identify the anatomical relationships among these structures in the jugular foramen region and lateral-pharyngeal space.
METHODS
A total of 60 sides of 30 non-embalmed cadavers were examined few hours after death. The diameters of the jugular foramen and its anatomical relationships were analyzed.
RESULTS
The diameters of the jugular foramen and internal jugular vein were greater on the right side in most studied specimens. The inferior petrosal sinus ended in the internal jugular vein up to 40mm below the jugular foramen; in 5% of cases. The glossopharyngeal nerve exhibited an intimate anatomical relationship with the styloglossus muscle after exiting the skull, and the vagal nerve had a similar relationship with the hypoglossal nerve. The accessory nerve passed around the internal jugular vein via its anterior wall in 71.7% of cadavers.
CONCLUSION
Anatomical variations were found in the dimensions of the jugular foramen and the internal jugular vein, which were larger in size on the right side of most studied bodies; variations also occurred in the trajectory and anatomical relationships of the nerves. The petrosal sinus can join the internal jugular vein below the foramen.
Topics: Accessory Nerve; Adult; Aged; Aged, 80 and over; Anatomic Variation; Dissection; Female; Glossopharyngeal Nerve; Humans; Jugular Foramina; Jugular Veins; Male; Middle Aged; Neck; Vagus Nerve
PubMed: 30348503
DOI: 10.1016/j.bjorl.2018.09.004 -
Folia Morphologica 2023Muscular and neurovascular variations in the upper extremity are of utmost clinical significance. Here we report a unique bilateral accessory muscle in the forearm and...
Muscular and neurovascular variations in the upper extremity are of utmost clinical significance. Here we report a unique bilateral accessory muscle in the forearm and palm of an 89-year-old male cadaver. The accessory muscle presented two bellies on the right side, one in the forearm, innervated by the anterior interosseous nerve, and the other in the palm, innervated by a branch of the median nerve. A long tendon interconnected the two bellies. On the left side, the muscle had a single belly in the palm, which began at the end of a long tendon that extended from the forearm. However, on both sides, the muscle originated from the posterior surface of the flexor digitorum superficialis belly and inserted along with the first lumbrical muscle into the dorsal digital expansion of the index finger. The proximal parts of the variant muscles were sandwiched between the flexor digitorum muscles. The palmar bellies coursed distally through the carpal canal and lay deep to the superficial palmar arch, and superficial to the first lumbrical, between the thenar muscles and the lateral-most tendon of the flexor digitorum superficialis. Arguably, the accessory muscle might be a variant of a lumbrical muscle, as reported before, but innervation of the proximal belly by the anterior interosseous nerve suggests that the muscle may well be a deep accessory muscle at the forearm, probably appeared as a diverted part of the flexor digitorum profundus. Its space-occupying course through the forearm and palm, especially through the carpal canal, might be clinically significant as it might contribute to nerve compression pathologies in the upper extremity. This accessory muscle also indicates the complex nature of individual muscle formation and evolution of the upper extremity with constant changes in the morphology of muscles based on their changing functions.
Topics: Male; Humans; Aged, 80 and over; Forearm; Muscle, Skeletal; Tendons; Wrist; Hand; Carpal Tunnel Syndrome; Musculoskeletal Abnormalities; Cadaver
PubMed: 35411546
DOI: 10.5603/FM.a2022.0037 -
Clinical Neurophysiology : Official... Jan 2022Compare high-resolution ultrasound (HRUS) and electrodiagnostic examination (EDX) in the diagnostic workup of patients with scapulae alatae. (Comparative Study)
Comparative Study
OBJECTIVE
Compare high-resolution ultrasound (HRUS) and electrodiagnostic examination (EDX) in the diagnostic workup of patients with scapulae alatae.
METHODS
27 patients with scapulae alatae and 41 healthy subjects (HS) and underwent a standardized clinical examination (CEX), EDX and HRUS. We measured the thickness of the serratus anterior (SER), rhomboid major and trapezius muscles and the diameter of the long thoracic (LTN), dorsal scapular and spinal accessory nerves (SAN).
RESULTS
Twenty patients showed medial winging and six patients showed lateral winging on CEX. One patient had both lateral and medial winging. In patients with medial winging, the SER muscle was thinner and the LTN diameter was larger on the symptomatic side compared with the asymptomatic side and with the dominant side in HS. In this group, both EDX and HRUS detected abnormalities of SER muscle/ LTN with sensitivity of 65%, and with specificity of 100% and 57%, respectively. EDX and HRUS detected abnormalities of the trapezius muscle/ SAN with sensitivity of 60% and 40%, and specificity of 91%, and 86 % a, respectively. There was no significant difference between the two methods.
CONCLUSION
HRUS can contribute to the diagnostic workup of scapulae alatae by demonstrating atrophy of muscles and enlargement in nerve diameter.
SIGNIFICANCE
HRUS supplements EDX in the diagnostic workup of scapulae alatae.
Topics: Adult; Case-Control Studies; Electrodiagnosis; Female; Humans; Male; Middle Aged; Neuromuscular Diseases; Scapula; Ultrasonography
PubMed: 34801963
DOI: 10.1016/j.clinph.2021.09.021 -
BioMed Research International 2015This study aimed to bring the trapezius muscle knowledge of the locations where the accessory nerve branches enter the muscle belly to reach the motor endplates and find...
This study aimed to bring the trapezius muscle knowledge of the locations where the accessory nerve branches enter the muscle belly to reach the motor endplates and find myofascial trigger points (MTrPs). Although anatomoclinical correlations represent a major feature of MTrP, no previous reports describing the distribution of the accessory nerve branches and their anatomical relationship with MTrP are found in the literature. Both trapezius muscles from twelve adult cadavers were carefully dissected by the authors (anatomy professors and medical graduate students) to observe the exact point where the branches of the spinal accessory nerve entered the muscle belly. Dissection was performed through stratigraphic layers to preserve the motor innervation of the trapezius muscle, which is located deep in the muscle. Seven points are described, four of which are motor points: in all cases, these locations corresponded to clinically described MTrPs. The four points were common in these twelve cadavers. This type of clinical correlation between spinal accessory nerve branching and MTrP is useful to achieve a better understanding of the anatomical correlation of MTrP and the physiopathology of these disorders and may provide a scientific basis for their treatment, rendering useful additional information to therapists to achieve better diagnoses and improve therapeutic approaches.
Topics: Adult; Cadaver; Female; Humans; Male; Muscle, Skeletal; Trigger Points
PubMed: 25811029
DOI: 10.1155/2015/623287 -
European Annals of Otorhinolaryngology,... May 2017The neck dissection technique has been precisely defined. It allows resection of lymph node groups, comprising at least groups IIA, IIB, III and IV according to...
The neck dissection technique has been precisely defined. It allows resection of lymph node groups, comprising at least groups IIA, IIB, III and IV according to Robbins' classification for head and neck cancer. Neck dissection is classically performed in an upwards and forwards direction, but the technique can vary according to the site of lymph nodes. The authors describe the central role of dissection of the triangle between the spinal accessory nerve and the internal jugular vein at the beginning of neck dissection in order to facilitate group IIB dissection while avoiding traction on the spinal accessory nerve and to ensure early control of the internal jugular vein superiorly; release of the vein also facilitates subsequent dissection of the thyrolinguofacial trunk and identification of the hypoglossal nerve. This specific dissection and its role has not been previously described in the literature. This triangle constitutes the posterior part of group IIA, but is intimately related anatomically to group IIB dissection.
Topics: Accessory Nerve; Head and Neck Neoplasms; Humans; Jugular Veins; Lymph Node Excision; Lymphatic Metastasis; Neck Dissection
PubMed: 27840043
DOI: 10.1016/j.anorl.2016.10.002 -
Diagnostics (Basel, Switzerland) Jan 2022Occipital neuralgia (ON) is a condition defined as a headache characterized by paroxysmal burning and stabbing pain located in the distribution of the greater occipital...
Occipital neuralgia (ON) is a condition defined as a headache characterized by paroxysmal burning and stabbing pain located in the distribution of the greater occipital nerve (GON), lesser occipital nerve (LON), or third occipital nerves (TON). This condition can be severely impairing in symptomatic patients and is known to have numerous etiologies deriving from various origins such as trauma, anatomical abnormalities, tumors, infections, and degenerative changes. This study reports four cases of a previously undescribed anatomical variant in which the (spinal) accessory nerve (SAN) fuses with the LON before piercing the sternocleidomastoid (SCM). The fusion of these two nerves and their route through the SCM points to a potential location for nerve compression within the SCM and, in turn, another potential source of ON. This anatomical presentation has clinical significance as it provides clinicians with another possible cause of ON to consider when diagnosing patients who present with complaints of a headache. Additionally, this study explores the prevalence of piercing anatomy of the LON and GAN and discusses their clinical implications.
PubMed: 35054305
DOI: 10.3390/diagnostics12010139 -
Proceedings of the Royal Society of... Jan 1972
Topics: Accessory Nerve; Arteriovenous Malformations; Brain; Brain Neoplasms; Cerebellopontine Angle; Cerebral Arteries; Electrocoagulation; Facial Nerve; Humans; Intracranial Aneurysm; Intracranial Embolism and Thrombosis; Microscopy; Microsurgery; Trigeminal Nerve
PubMed: 4536915
DOI: No ID Found -
Hand Surgery & Rehabilitation Apr 2023
Topics: Humans; SARS-CoV-2; Brachial Plexus Neuritis; COVID-19; Accessory Nerve
PubMed: 36608847
DOI: 10.1016/j.hansur.2022.12.004 -
International Archives of... Oct 2015Introduction Most patients after either superficial or total parotidectomy develop facial deformity and Frey syndrome, which leads to a significant degree of patient...
Introduction Most patients after either superficial or total parotidectomy develop facial deformity and Frey syndrome, which leads to a significant degree of patient dissatisfaction. Objective Assess the functional outcome and esthetic results of the superiorly based sternocleidomastoid muscle (SCM) flap after superficial or total parotidectomy. Methods A prospective cohort study for 11 patients subjected to parotidectomy using a partial-thickness superiorly based SCM flap. The functional outcome (Frey syndrome, facial nerve involvement, and ear lobule sensation) and the esthetic results were evaluated subjectively and objectively. Results Facial nerve palsy occurred in 5 cases (45%), and all of them recovered completely within 6 months. The Minor starch iodine test was positive in 3 patients (27%), although only 1 (9%) subjectively complained of gustatory sweating. The designed visual analog score completed by the patients themselves ranged from 0 to 3 with a mean of 1.55 ± 0.93; the scores from the blinded evaluators ranged from 1 to 3 with a mean 1.64 ± 0.67. Conclusion The partial-thickness superiorly based SCM flap offers a reasonable cosmetic option for reconstruction following either superficial or total parotidectomy by improving the facial deformity. The flap also lowers the incidence of Frey syndrome objectively and subjectively with no reported hazard of the spinal accessory nerve.
PubMed: 26491478
DOI: 10.1055/s-0035-1549155 -
Cureus Apr 2021Anatomical variations of the craniocervical junction including a nerve of McKenzie, a branch between the spinal accessory nerve (XI) and the ventral root of the first...
Anatomical variations of the craniocervical junction including a nerve of McKenzie, a branch between the spinal accessory nerve (XI) and the ventral root of the first cervical nerve (C1), have been identified. During routine dissection, a nerve of McKenzie with an interneural connection between the cranial root of the accessory nerve and the vagus nerve was observed on the left side. To our knowledge, a case with these two anatomical variations in the same cadaver and on the same side has not previously been reported. These variants may complicate surgery of the nerves of the craniocervical junction, and should thus be appreciated by the surgeon. Here, we discuss this case, its possible embryological origins, and the clinical significance.
PubMed: 33972901
DOI: 10.7759/cureus.14343