Head and Neck
Bobby Krishnachetty, Abdul Syed, Harriet Scott in Applied Anatomy for the FRCA, 2020
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. There are four major branches arising from the cervical plexusSuperficial cervical plexus (sensory)Deep cervical plexus (motor)Phrenic nerve (discussed in detail a little later)Communicating branches (communicate with hypoglossal, accessory and vagus nerves and sympathetic nervous system via superior cervical ganglion)Superficial cervical plexus (sensory)The nerves supplying the lateral aspect of the neck arise from the anterior primary rami of C2, C3 and C4. C1 is motor and has no sensory supply to skin. The nerves emerge at the posterior border of sternocleidomastoid at approximately the midpoint between mastoid and sternum, also called Erb’s point (Figure 1.36 and Table 1.25).
Surgical Anatomy of the Neck
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
The cervical plexus nerves arise from the anterior rami of the upper four cervical spinal nerves. The cervical plexus lies deep to the prevertebral fascia and passes over the scalenus medius muscle. It has motor and sensory branches ( Figure 35.13 ). The sensory, or cutaneous branches of the cervical plexus emerge from the posterior border of the sternocleidomastoid muscle 1 cm superior to the emergence of the spinal accessory nerve at a point termed Erb’s point.These branches provide sensory innervation to the anterior neck, with four named branches:Lesser occipital nerve: Formed entirely from the C2 root this branch provides supply to the skin posterior to the pinna, up to the superior nuchal line.Greater auricular nerve: This branch is formed from C2 and C3 nerve roots and runs superiorly from Erb’s point, across the sternocleidomastoid muscle towards the parotid gland.It branches into anterior and posterior divisions.The anterior branch supplies sensation to the skin anterior and inferior to the pinna whereas the posterior branch supplies the inferior pinna including the lobule, the skin inferior to the pinna and provides innervation to the parotid capsule.The nerve is often injured during neck dissection or parotid surgery and may have to be sacrificed to enable access to these areas, resulting in insensate lobule and numbness of the upper neck and peri-auricular skin.Transverse cervical nerves: Fibres from the C2 and C3 nerve roots combine into a single nerve that leaves Erb’s point then passes anteriorly and branches multiple times to give sensory innervation the skin of the entire anterior neck.
Exposure for spinal surgery
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
The approach to the anterior aspect of C3 lies between the carotid sheath, which is reflected laterally, and the cervical visceral column, which is reflected medially. The pathology determines the laterality of the approach. The neck is extended and turned slightly to the contralateral side. An incision is made from the mastoid process, passing under the angle of the mandible and continuing anteriorly inferior to the mandible ( Figure 91.1 ). The platysma is incised in the same direction as the skin incision. The cutaneous sensory branches of the cervical plexus (lesser occipital, greater auricular, and transverse cervical nerves) should be avoided. The sternocleidomastoid muscle (SCM) is then retracted laterally and the “window of access” is opened. This window is bounded by the external carotid artery laterally, the pharynx at the level of the hyoid bone medially, the hypoglossal nerve superiorly, and the superior thyroid artery inferiorly ( Figure 91.2 ). As the pharynx is mobilized medially, the anterior surface of the vertebral column is reached. A nasogastric tube or bougie in the esophagus helps avoid injury during mobilization. The longus colli and longus capitus are separated in the midline, and the prevertebral fascia and anterior longitudinal ligament are divided in the midline to expose the anterior aspect of C3.
Superficial parotidectomy under local anesthesia, case report
Published in Egyptian Journal of Anaesthesia, 2017
For superficial parotidectomy general anesthesia is ideal, but certain patients may be unfit. The present case had uncontrolled hypertension together with difficult airway. To avoid any suspected complications, we decided to do the operation under local anesthesia. We planned to block the maxillary nerve and superficial cervical plexus with greater auricular nerve together with incision site infiltration. A mixture of bupivacaine 0.25% and lignocaine 1% with adrenaline 1: 200,000 was prepared. The block was effective after about 15–20 min and the surgery was performed uneventfully using only the nerve blocks with mild sedation.
Efficacy of unilateral combined (superficial and deep) cervical plexus block as a preemptive analgesia for unilateral neck dissection surgery
Published in Egyptian Journal of Anaesthesia, 2012
Salwa Mohamed Sabry Hayes, Hanaa Mahmoud El-Bendary, Eiad Ahmed Ramzy, Ahmed Musaad Abd El-Fattah, Ehsan Mohamed Abd El-Aty Rizk
ObjectivesThe objectives of this study were designed to evaluate the intra- and postoperative analgesic efficacy of unilateral superficial and deep cervical plexus block for unilateral neck dissection surgery. Patients and methodsTwenty eight patients were randomly assigned into two groups to receive either saline (control group) or bupivacaine (study group), hemodynamic monitoring. Bispectral index (BIS) monitor and MAC of isoflurane were recorded. Postoperative visual analogue score were recorded, operative time and postoperative first time to take analgesic were recorded. ResultsCompared to the control group, patients received bupivacaine for unilateral superficial and deep cervical plexus block showed lower intraoperative isoflurane concentration and bispectral index, decreased postoperative visual analogue score, longer duration of analgesia, decreased plasma cortisol level. No patients developed adverse effects. ConclusionUnilateral combined superficial and deep cervical plexus block is an effective technique to reduce intraoperative anesthetics and reduce postoperative analgesic requirements in patients undergoing unilateral block neck dissection surgery without any adverse effects.
Cervical plexus block for thyroidectomy
Published in Southern African Journal of Anaesthesia and Analgesia, 2003
Objective: Thyroidectomy is traditionally performed under general anaesthesia with endotracheal intubation. However, cervical plexus block has also been found useful for this operation in some parts of the world. This particular anaesthetic option has never been reported in our environment. The aims of this study were to assess the feasibility, safety, effectiveness and patients= acceptability of bilateral superficial cervical plexus block for thyroidectomy in our hospital. Design: This is a prospective study of all consenting adult patients who presented with goiter and had thyroidectomy done in a Nigerian Teaching Hospital, between May 1998 and September 1999. Setting: The study was carried out at the University of Ilorin Teaching Hospital, which is a tertiary health institution. Subjects: The study included seventeen (17) Patients above the age of 18 years who presented with goiter and had elective thyroidectomy done within the study period. Outcome Measures/Results: The 17 patients represented 65% of all those who underwent thyroidectomy in our hospital within the study period. There were 15 females and 2 males, giving a female to male ratio of 7.5:1. The median age of the patients was 44 (range 20–80) years. Types of goiter included 13 simple multinodular or nodular goiters, 3 diffuse toxic goiters and 1 malignant goiter. Sixteen (16) patients had subtotal thyroidectomy, while one had total thyroidectomy. Varying degrees of pressure symptoms during mobilization of the gland, and postural aches were some of the intra-operative problems encountered. These problems were described by the patients as tolerable. Fifteen (88%) of the patients found the anaesthesia satisfactory and would not mind recommending or having the same anaesthetic technique for similar procedure. Two (12%) of the patients expressed dissatisfaction with the anaesthesia and would not want it for similar procedure. In one of the two, the surgery was completed under general anaesthesia with endotracheal intubation when the block was found to be ineffective. The second patient became extremely apprehensive during surgery, although she denied experiencing any significant pain and refused conversion to general anaesthesia. Conclusion: Bilateral superficial cervical plexus block is a useful anaesthetic option for thyroidectomy in temperamentally suited patients. Although the number was small, we can conclude that the block is feasible, safe, effective and easy to perform. It was acceptable to our patients.