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Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The cervical plexus is formed from the ventral rami of C1–C4 which pass along the transverse process of their respective vertebrae, before receiving grey rami communicantes from the superior cervical ganglion. As they pass behind the vertebral artery and reach the end of the transverse process, they split into ascending and descending branches, before forming nerve loops which form the cervical plexus.
Nina: The Use of Potent Opioids in a Complex Chronic Pain Patient
Published in Michael S. Margoles, Richard Weiner, Chronic PAIN, 2019
On 9/11/95, this patient had a procedure performed by Dr. Bojeff. The patient stated, and I always found her to be reliable, that she was under the impression that she was going to undergo a nerve block in the cervical spine and possibly the cervical plexus. There was no signature given for performing any lesioning procedure in the cervical spine area. The following is a quote from the operative note of that date. The note was dictated by Dr. Bojeff: The patient was positioned on the x-ray table, an intravenous axis line was placed. IV Versed was given for preop sedation. Monitors were placed and vital signs were obtained and recorded. Then landmarks were checked and the appropriate levels were marked.After adequate anesthesia was obtained, the block was then performed with a 22 gauge SMK block needle advanced to the lateral border of the lateral body of the vertebrae. Position confirmed by A/A-P and lateral views. The nerve was stimulated at 2 Hz and again at 50 Hz and was checked for sensory distribution and lack of motor function. Then aspirated to confirm that it was not in a vascular space before injection. Blocked the nerve with 1 cc 0.5% Marcaine under fluoroscopic guidance. Then the nerve was lesioned with RF to produce a lesion at 80 degrees centigrade for 90 seconds at each site in the C3, C4, C5 and C6. Discharged home in good condition, pain free.
Blocks of Nerves Supplying the Head and Neck
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The cervical plexus results from the union of the ventral rami of the first four cervical spinal nerves. These rami arise from the intervertebral foramina, pass behind the vertebral artery, then lie close to the dorsal aspect of the transverse process, in the groove formed by the anterior and posterior tubercles of this process. After their emergence from this groove, they divide into upper and lower branches, which unite in a complex manner to form the cervical plexus (Figure 4.22A).
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
GTs are usually benign, soft-tissue neoplasms originating from the thermoregulatory neuromyoarterial glomus bodies. There are several theories regarding the pathogenesis of neuronal GT, such as infiltration from extra-neural tissues or development from intraneural ectopic glomus cells, but it is currently believed that the neoplasm develops through the differentiation of unspecialized perivascular cells, the pericytes [7]. Those areas rich in glomus bodies such as the subungual regions of the digits and the deep dermis of the palms, wrists, forearms, and feet are typically involved. However, cases of GTs arising from organs thought to be without glomus bodies such as the mediastinum, nasal cavity, tongue, lung, trachea, mediastinum, gastrointestinal tract, genitalia, bones, pterygoid fossa, knee, and blood vessels, have also been described [1–3]. Nevertheless, the involvement of peripheral nerves remains extremely rare and their true incidence is likely underestimated [5]. To date, only 24 cases of peripheral nerve GTs have been described in the literature. The majority of the cases reported intraneural GTs, while a small percentage referred to cases of epineural GTs and glomangiomatosis [7]. Peripheral nerves of the extremities are almost always affected with a slight prevalence of the upper limbs [1,3,7–18] on the lower limbs [3–5,19–25]. The tumors ranged from <0.4 mm to about 11 cm in size, and with the exception of two cases [10,13], they were all single lesions. Therefore, before our patient, no cases of peripheral nerve GTs of the cervical plexus had been reported.
Levobupivacaine versus levobupivacaine – dexmedetomidine for ultrasound guided bilateral superficial cervical plexus block for upper tracheal resection and reconstruction surgery under general anesthesia
Published in Egyptian Journal of Anaesthesia, 2022
Hanaa M. El Bendary, Ahmed M Abd El-Fattah, Hisham A Ebada, Salwa MS Hayes
Anesthesia for repair of tracheal stenosis and reconstruction surgeries not only needs understanding the surgical procedures, but it needs also cooperation with the surgical team specially with surgical manipulations at the airway during resection and anastomosis and also the management of emergence and postoperative care [15]. So it is important to use techniques that optimize the immediate postoperative period and preventing too early or too late extubation and unwise use of postoperative opioid that results in immediate loss of the airway patency which increases the risk of reintubation but with difficult situation or it may lead to performance of emergent tracheostomy. As the superficial cervical plexus supplies the skin of the anterolateral neck via the anterior primary rami form the second to fourth cervical nerves so the SCP block considered as one of the techniques that causes anesthesia of the anterior triangle of the neck.
The devil is in the details: developing a modern methodology for detailed medical illustrations
Published in Journal of Visual Communication in Medicine, 2021
Emily M. Adams, Caroline Erolin
ZSpheres were used to build the vessels and the nerves after the muscles, glands, and thyroid were colourized. ZSpheres were chosen for building vessels and nerves because they allowed for the creation of thin long structures. Each sphere added creates a new connection between the previous spheres (see Figure 5). To make the ZSpheres an editable subtool, the Adaptive Skin Option was used. On the right side, the terminal ends of the cutaneous branches were added to the skinned cervical plexus. The Sternocleidomastoid transparency was adjusted using Display Properties > BPR Settings to adjust the muscle so the cutaneous nerve origins could be seen below the SCM (see Figure 6). Due to time limitations, the number of nerve and vessel branches included in the final 3D model was less than anticipated. This may have had inadvertent effects on the results of the survey, as many participants noted the new visual was easier to understand than Pernkopf’s.