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Cranial Neuropathies I, V, and VII–XII
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
The spinal accessory nerve is a motor nerve arising partly from the nucleus ambiguus in the medulla and partly from upper cervical segments. It supplies two muscles: the sternocleidomastoid and the trapezius (Figure 21.19).49
Surgical Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Damage to the following nerves causes specific signs and symptoms: Recurrent laryngeal branch of the vagus: hoarseness and vocal cord paralysis.Accessory nerve: loss of function of trapezius and sternomastoid.Phrenic nerve: loss of diaphragmatic movement, elevated hemidiaphragm on x-ray.Hypoglossal nerve: deviation of the tongue to the affected side.Cervical sympathetic cord: Horner's syndrome, with partial ptosis, a constricted pupil, and decreased sweating on the same side of the face.
The Head and Neck
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Radical neck dissection is carried out prophylactically or therapeutically to remove regional lymph nodes. The indications for radical cervical lymphadenectomy have been discussed under each site. It includes removal of all lymph bearing area between the two layers of the deep cervical fascia. Certain muscles, such as the sternocleidomastoid and omohyoid muscles, may be sacrificed, as these lie within the space. Other muscles, such as the strap muscles and the thyroid gland, are to be resected as in the case of translaryngeal carcinomas. The digastric muscle may be resected for large tumors of the oral cavity. In a standard radical neck dissection, the internal jugular vein is removed. The only structures to be preserved are the muscles that form the floor of the neck, the carotid artery, the vagus and phrenic nerves, and the lingual and hypoglossal nerves. The accessory nerve can be preserved if the neck dissection is carried out prophylactically or electively, i.e., if there is no gross evidence of lymph node metastases. However, controversy continues with regard to the preservation of the accessory nerve in therapeutic neck dissection, i.e., with gross lymph node metastases.
Post-traumatic glomus tumor of the left anterior supraclavicular nerve: a case report
Published in Neurological Research, 2023
Alessandra Turrini, Guido Staffa, Giulio Rossi, Crescenzo Capone
Because of the disabling pain, we proposed to attempt surgery to remove the lesion. On surgical exploration under general anesthesia, the sensitive branch of the left medial supraclavicular nerve ended in a hard mass, apparently in continuity with an ectatic left transverse cervical artery (Figure 2a). The accessory nerve was not involved but in close anatomical relation with it (Figure 2b). Due to the resemblance to a thrombosed pseudoaneurysm related to a traumatic neuroma, the arterial branches were ligated and the lesion was radically excised. Histopathological evaluation showed a mesenchymal neoplasm with both spindle and epithelial cells, some mitotic Figures (1–2 x 10 HPF), and absence of necrosis (Figure 3a,b). Immunohistochemistry stain highlighted a heterogeneous labeling index Ki67 of 4% and positivity of actin-ML and collagen type IV (Figure 3c–e). Despite the preoperative suspicion and the intraoperative appearance, the histological examination revealed a glomangiomyoma. An uneventful postoperative recovery was noted and the painful symptoms promptly regressed after surgery. No recurrence has occurred after 18 months of follow up.
Shoulder abduction reconstruction for C5–7 avulsion brachial plexus injury by dual nerve transfers: spinal accessory to suprascapular nerve and partial median or ulnar to axillary nerve
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Gavrielle Hui-Ying Kang, Fok-Chuan Yong
All surgeries were performed in the supine position. A supraclavicular approach was used for brachial plexus roots exploration and nerve transfer of the spinal accessory to the suprascapular nerve. The spinal accessory nerve was identified on the deep surface of the trapezius muscle and confirmed with a nerve stimulator. The dissection was continued distally to its termination into two or three branches. A vessel loop was placed around it for later identification when it would be transected at this junction for coaptation to the suprascapular nerve stump. The suprascapular nerve was identified as it branches off from the upper trunk of the brachial plexus. It was dissected and traced distally until healthy nerve tissue was encountered. This was verified by its turgor and the visualization of nerve fascicles within the epineurium upon transection of the nerve. When scarred or fibrotic nerve tissue was encountered, the nerve would be progressively cut back distally until a healthy nerve stump was seen. Coaptation of the spinal accessory nerve to the healthy suprascapular nerve stump was performed under magnification with 10–0 nylon sutures, and reinforced with a biological adhesive (TISSEEL Fibrin Sealant, Baxter International Inc.).
Scapula muscle exercises using the Neurac technique for a patient after radical dissection surgery: a case report
Published in Physiotherapy Theory and Practice, 2020
After radical neck dissection, more than 67% of patients report experiencing shoulder pain and dysfunction (McNeely et al., 2008; van Wilgen et al., 2004). It is believed that such disorders result from injury or resection of the spinal accessory nerve, and such injuries cause trapezius muscle weakness (Kendall, McCreary, and Provance, 1993; McGarvey, Chiarelli, Osmotherly, and Hoffman, 2011). This muscle weakness presents as scapula winging, dropping, and medial rotation at rest, as well as reduced scapula elevation, upward rotation caused by decreased glenohumeral joint abduction, and flexion under dynamic situations (Hillel, Kroll, Dorman, and Medieros, 1989; McGarvey, Osmotherly, Hoffman, and Chiarelli, 2013). Altered scapula kinematics may result in mechanical overload in the shoulder joint, which may cause shoulder pain and dysfunction, and affect quality of life (Chepeha et al., 2002).