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Anaesthesia Nov 2011
Topics: Accessory Nerve; Humans; Male; Myofascial Pain Syndromes; Nerve Block; Ultrasonography
PubMed: 22004211
DOI: 10.1111/j.1365-2044.2011.06908_1.x -
JB & JS Open Access 2019Acute flaccid myelitis (AFM) is a debilitating illness that is defined by the sudden onset of flaccid paralysis in the extremities with spinal magnetic resonance imaging...
UNLABELLED
Acute flaccid myelitis (AFM) is a debilitating illness that is defined by the sudden onset of flaccid paralysis in the extremities with spinal magnetic resonance imaging (MRI) demonstrating a longitudinal lesion confined to the gray matter. The purpose of this study was to report the types of upper-extremity palsy and outcomes of surgical reconstruction in patients with AFM.
METHODS
Eight patients with a median age at onset of 3.8 years (range, 2.3 to 9.9 years) were identified. There was loss of shoulder abduction and external rotation in all patients, loss of elbow flexion in 5 patients, complete or partial loss of hand function in 3 patients, and spinal accessory nerve palsy in 2 patients. All patients underwent surgical reconstruction, which was categorized into 3 main groups: nerve transfer, secondary muscle transfer, and free muscle transfer.
RESULTS
The median follow-up period was 39 months (range, 30 to 94 months). Four patients obtained ≥90° of shoulder abduction whereas the other 4 patients had shoulder abduction of ≤70°. The 5 patients who received free muscle transfer or nerve transfer to restore elbow function obtained ≥140° of elbow flexion. Two patients treated with free muscle transfer to restore finger function obtained satisfactory total active motion of the fingers (180°).
CONCLUSIONS
The patterns of paralysis and the strategy and outcomes of surgical reconstruction for patients with AFM differed from those for traumatic and obstetric brachial plexus palsy. All patients had loss of shoulder abduction, and 2 had spinal accessory nerve palsy. Restoration of shoulder function was unpredictable and depended on the quality of the donor nerves and recovery of synergistic muscles. Restoration of elbow and hand function was more consistent and satisfactory.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete list of levels of evidence.
PubMed: 32043059
DOI: 10.2106/JBJS.OA.19.00030 -
Plastic and Reconstructive Surgery.... Aug 2023Massive resection of a malignant tumor of the head and neck region often requires loss of critical nerves, including the spinal accessory nerve. Recently, vascularized...
Massive resection of a malignant tumor of the head and neck region often requires loss of critical nerves, including the spinal accessory nerve. Recently, vascularized nerve grafts (VNGs) have been used to repair facial and other nerve defects with successful outcomes, even in cases involving factors that can inhibit nerve regeneration, such as radiotherapy. However, the effectiveness of these nerve grafts against postoperative radiotherapy has yet to be explored. We report the first successful case in reconstructing a spinal accessory nerve defect after total left parotidectomy with radical neck dissection, using a vascularized vastus lateralis motor nerve graft and an anterolateral thigh flap based on the lateral circumflex femoral system, with great shoulder function outcomes even after postoperative radiotherapy. A branch of vastus lateralis motor nerve perfused by the accompanying descending branch of lateral femoral circumflex vessel was used as a nerve graft, and was repaired in an end-to-end manner. The patient underwent postoperative radiotherapy to the area of operation. At 6-months follow-up, the patient was capable of 90 degrees lateral shoulder abduction, and at 18 months, achieved full-range shoulder abduction and reported neither functional limitations of the shoulder nor complaints of any shoulder pain (Disabilities of Arm, Shoulder, and Hand score 0). Although further study is necessary to fully understand the superiority of VNGs over postoperative radiotherapy, immediate nerve reconstruction using VNG for accessory nerve defects in patients scheduled for radiotherapy postoperation may be extremely beneficial for preserving shoulder motor function and sustaining the patient's quality of life.
PubMed: 37621917
DOI: 10.1097/GOX.0000000000005174 -
PM & R : the Journal of Injury,... Dec 2014To determine the association of neck dissection and radiation treatment for head and neck cancer (HNC) with subsequent shoulder range of motion (ROM) and quality of life...
OBJECTIVE
To determine the association of neck dissection and radiation treatment for head and neck cancer (HNC) with subsequent shoulder range of motion (ROM) and quality of life (QOL) in 5-year survivors.
DESIGN
A cross-sectional convenience sample.
SETTING
Otolaryngology clinics at tertiary care hospital and Veterans Affairs medical center.
PATIENTS
Five-year, disease-free survivors of HNC.
METHODS
Demographic and cancer treatment information was collected, including type of neck dissection (none, spinal accessory "nerve sparing," and "nerve sacrificing") and radiation. QOL questionnaires were administered, and shoulder ROM was measured.
MAIN OUTCOME MEASUREMENTS
University of Washington Quality of Life (UWQOL), Functional Assessment of Cancer Therapy (FACT) Head and Neck, and Performance Status Scale for Head and Neck. Shoulder ROM measurements included abduction, adduction, flexion, extension, internal and external rotation.
RESULTS
One hundred and five survivors completed QOL surveys; 85 survivors underwent additional shoulder ROM evaluations. The nerve sacrifice group exhibited significantly poorer scores for UWQOL measures of disfigurement, level of activity, recreation and/or entertainment, speech and shoulder disability, and willingness to eat in public, FACT functional well-being, and FACT Head and Neck (P < .05). Shoulder ROM for flexion and abduction was poorest in the nerve sacrifice group (P < .05). Radiation was associated with significantly worse UWQOL swallowing (P < .05), but no other differences were found for QOL or ROM measurements. Decreased QOL scores were associated with decreased shoulder flexion and abduction (P < .05). Survivors with decreased shoulder abduction had significantly (P < .05) worse scores in disfigurement, recreation and/or entertainment, employment, shoulder disability, and FACT emotional well-being.
CONCLUSIONS
Sparing the spinal accessory nerve during neck dissection is associated with significantly less long-term shoulder disability in 5-year survivors of HNC. QOL measures demonstrated the highest level of function in the no dissection group, an intermediate level of functioning with nerve sparing, and poorest function when the nerve is sacrificed. Decreased shoulder flexion and abduction is associated with reduced QOL in long-term survivors of HNC.
Topics: Accessory Nerve; Aged; Cross-Sectional Studies; Disease-Free Survival; Female; Head and Neck Neoplasms; Humans; Male; Quality of Life; Range of Motion, Articular; Shoulder; Surveys and Questionnaires; Survivors
PubMed: 24880060
DOI: 10.1016/j.pmrj.2014.05.015 -
Acta Medica (Hradec Kralove) 2016In the current cadaveric study an unusual sizeable accessory phrenic nerve (APN) was encountered emerging from the trunk of the supraclavicular nerves and forming a...
In the current cadaveric study an unusual sizeable accessory phrenic nerve (APN) was encountered emerging from the trunk of the supraclavicular nerves and forming a triangular loop that was anastomosing with the phrenic nerve. That neural loop surrounded the superficial cervical artery which displayed a spiral course. The form of a triangular loop of APN involving the aforementioned artery and originating from the supraclavicular nerve to the best of our knowledge has not been documented previously in the literature. The variable morphological features of the APN along with its clinical applications are briefly discussed.
Topics: Aged; Arteries; Cervical Vertebrae; Humans; Male; Neck; Phrenic Nerve
PubMed: 27526310
DOI: 10.14712/18059694.2016.55 -
Annals of the Royal College of Surgeons... Apr 2014The retrojugular approach for carotid endarterectomy (CEA) has been reported to have the advantages of shorter operative time and ease of dissection, especially in high... (Comparative Study)
Comparative Study Meta-Analysis Review
INTRODUCTION
The retrojugular approach for carotid endarterectomy (CEA) has been reported to have the advantages of shorter operative time and ease of dissection, especially in high carotid lesions. Controversial opinion exists with regard to its safety and benefits over the conventional antejugular approach.
METHODS
A systematic review of electronic information sources was conducted to identify studies comparing outcomes of CEA performed with the retrojugular and antejugular approach. Synthesis of summary statistics was undertaken and fixed or random effects models were applied to combine outcome data.
FINDINGS
A total of 6 studies reporting on a total of 740 CEAs (retrojugular approach: 333 patients; antejugular approach: 407 patients) entered our meta-analysis models. The retrojugular approach was found to be associated with a higher incidence of laryngeal nerve damage (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 1.46-7.07). No significant differences in the incidence of hypoglossal or accessory nerve damage were identified between the retrojugular and antejugular approach groups (OR: 1.09 and 11.51, 95% CI: 0.31-3.80 and 0.59-225.43). Cranial nerve damage persisting during the follow-up period was similar between the groups (OR: 2.96, 95% CI: 0.79-11.13). Perioperative stroke and mortality rates did not differ in patients treated with the retrojugular or antejugular approach (OR: 1.26 and 1.28, 95% CI: 0.31-5.21 and 0.25-6.50).
CONCLUSIONS
Currently, there is no conclusive evidence to favour one approach over the other. Proof from a well designed randomised trial would help determine the role and benefits of the retrojugular approach in CEA.
Topics: Cranial Nerve Injuries; Endarterectomy, Carotid; Epidemiologic Methods; Humans; Ischemic Attack, Transient; Stroke; Treatment Outcome
PubMed: 24780780
DOI: 10.1308/003588414X13814021679357 -
International Archives of... Oct 2018Papillary thyroid carcinoma has a very high rate of lateral neck node metastases, and there is almost unanimity concerning the fact that some sort of formal neck... (Review)
Review
Papillary thyroid carcinoma has a very high rate of lateral neck node metastases, and there is almost unanimity concerning the fact that some sort of formal neck dissection must be performed to address the clinical neck disease in these cases. Although there is an agreement that levels II to IV need to be cleared in these patients, the clearance of level V is debatable. We herein have tried to analyze various papers that have documented a structured approach to neck dissection in these patients. Moreover, we have also tried to consider this issue through various aspects, like spinal accessory nerve injury and the impact of neck recurrence on survival. The PubMed, Medline, Google Scholar, Surveillance, Epidemiology, and End Results (SEER), and Ovid databases were searched for studies written in English that focused on lateral neck dissection (levels II-IV or II-V) for papillary thyroid carcinoma. Case reports with 10 patients or less were excluded. The current evidence is equivocal whether to clear level V or not, and the studies published on this issue are very heterogeneous. Level II-IV versus level II-V selective neck dissections in node-positive papillary thyroid carcinoma patients is far from categorical, with pros and cons for both approaches. Hence, we feel that there is a need for more robust homogeneous data in order to provide an answer to this question.
PubMed: 30357101
DOI: 10.1055/s-0037-1608909 -
Journal of Neurological Surgery Reports Apr 2023Duplicate cranial nerves are fundamentally rare anatomical variants. Few case reports have documented cranial nerve duplication. One previous case report has...
Duplicate cranial nerves are fundamentally rare anatomical variants. Few case reports have documented cranial nerve duplication. One previous case report has reported a vagus nerve with a smaller secondary accessory nerve component. We present the first reported case of duplicate vagus nerves identical in size and thickness with otolaryngological diagnostic confirmation. A 25-year-old woman with seizures refractory to medical management decided to undergo placement of a vagus nerve stimulator. During carotid sheath microdissection, two parallel nerve tracts were identified. The two nerves were identical in size and width. Proximal dissection confirmed that the two nerves were independent of one another and neither was a branching segment. To confirm duplicate vagus nerves, otolaryngology was consulted intraoperatively and the duplicate nerves were verified. The vagus nerve stimulator was placed in typical fashion around the medial nerve. This is the first reported case of duplicate vagus nerves identical in size and with confirmation by otolaryngology. The authors would like to highlight the operative management of the vagus nerve stimulator placement as well as integrity of the diagnostic conclusions based on size, further dissection, and specialist consultation.
PubMed: 37213414
DOI: 10.1055/s-0043-1768713 -
Cureus Dec 2021Hypoglossal nerve palsy is usually associated with glossopharyngeal nerve, vagus nerve, and accessory nerve palsy, and the occurrence of hypoglossal nerve palsy alone...
Hypoglossal nerve palsy is usually associated with glossopharyngeal nerve, vagus nerve, and accessory nerve palsy, and the occurrence of hypoglossal nerve palsy alone is rare. We report a case of a 41-year-old man with unilateral isolated hypoglossal nerve palsy. The patient was aware of a leftward deviation of the tongue along with pharyngeal pain. The pharyngeal pain was quickly relieved by antibiotic treatment, but the deviation of the tongue did not improve, and the patient was referred to our hospital. As a result of the medical examination, a single paralysis of the left hypoglossal nerve and mild swelling of the left lingual tonsil up to the left palatine tonsil were observed. Various tests were performed, but there were no significant abnormal findings other than a suggestion of mild tonsillitis. We diagnosed the patient as idiopathic or tonsillitis-induced unilateral hypoglossal nerve palsy and started medical treatment with corticosteroids and methylcobalamin. The hypoglossal nerve palsy showed a tendency to improve after one month of onset and was almost cured by two months of onset.
PubMed: 35028202
DOI: 10.7759/cureus.20291 -
Anatomical Record (Hoboken, N.J. : 2007) Oct 2013This study examined C1 spinal nerve roots and their anastomotic connections with the spinal accessory nerve for histological evidence of sensory neurons in adult humans....
This study examined C1 spinal nerve roots and their anastomotic connections with the spinal accessory nerve for histological evidence of sensory neurons in adult humans. C1 spinal nerves and roots with the adjacent segments of the spinal accessory nerve and the spinal cord were dissected en bloc from cadaveric specimens, and prepared for histological study. Results show that in 39.3% of specimens studied, no sensory component to the C1 spinal nerve could be identified. The C1 dorsal root was present 35.7% of the time, and when present it always contained neuronal cell bodies. In the remaining specimens, the sensory contribution to the C1 spinal nerve came through an anastomotic connection with the spinal accessory nerve. The investigators were able to identify clusters of neuronal cell bodies along the spinal accessory nerve at the level of C1 in 100% of the specimens examined.
Topics: Accessory Nerve; Adult; Aged; Aged, 80 and over; Cadaver; Female; Humans; Male; Microscopy; Middle Aged; Sensory Receptor Cells; Spinal Cord; Spinal Nerve Roots; Spinal Nerves
PubMed: 23929774
DOI: 10.1002/ar.22757