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. 2020 Sep;58(3):149-154.
doi: 10.5152/tao.2020.5263. Epub 2020 Sep 1.

Accessory Nerve Anatomy in Anterior and Posterior Cervical Triangle: A Fresh Cadaveric Study

Mehmet Akif Abakay  1 , Selçuk Güneş  1 , Ceyhun Küçük  2 , Zahide Mine Yazıcı  1 , Filiz Gülüstan  1 , Murat Nihat Arslan  2 , İbrahim Sayın  1
Affiliations

Accessory Nerve Anatomy in Anterior and Posterior Cervical Triangle: A Fresh Cadaveric Study

Mehmet Akif Abakay et al. Turk Arch Otorhinolaryngol. 2020 Sep.

Abstract

Objective: To understand the variations and normal course of the accessory nerve (CNXI) to help more accurate and confident neck dissection.

Methods: The course of the CNXI in the neck, its relationship to the surrounding anatomic structures and the factors affecting its course were investigated.

Results: A total of 100 neck dissections were performed on 50 fresh cadavers. Eleven division variations were observed at the anterior triangle. The location of CNXI at the posterior border of the sternocleidomastoid muscle (PBSCM) was investigated and the ratio between the distance from the mastoid apex (MAA) to CNXI at the PBSCM and the distance from MAA to the posterior border where the PBSCM is attached to the clavicle increased as height of the subject increased (p<0.05).

Conclusion: It must be kept in mind that it is better to search for CNXI in taller subjects more inferiorly at the posterior border of the sternocleidomastoid muscle.

Keywords: Accessory nerve; Erb’s point; anatomy; injury; neck dissection; sternocleidomastoid muscle.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Anatomic structures and points seen after elevation of the subplatysmal flap, right neck EJV: external jugular vein; CNXI: trapezial branch of accessory nerve. *: great auricular nerve; N: cutaneous branches of the cervical plexus nerves; E: Erb’s point; TM: trapezius muscle; SCM: sternocleidomastoid muscle; green arrow: MAA-CNXI at PBSCM distance; blue arrow: MAA-ClavicleS; red arrow: Trap-ClavicleN; yellow arrow: SCMpostCNXI-Trap distance
Figure 2
Figure 2
Division variation in anterior triangle and connection with C2 nerve (right neck, sternocleidomastoid muscle clavicular attachments cut and muscle pulled laterally) ¶: External jugular vein; formula image : accessory nerve; thin arrow: trapezial branch of accessory nerve; thick arrow: sternocleidomastoid branch of accessory nerve; lightning: connection between CNXI and C2
Figure 3
Figure 3
Division variation in anterior triangle with double entrance to sternocleidomastoid muscle (left neck, SCM clavicle attachments cut and muscle pulled laterally) formula image: accessory nerve; thin arrow: trapezial branch of accessory nerve; thick arrow: sternocleidomastoid branch of accessory nerve
Figure 4
Figure 4
Division in anterior triangle and relationship to other anatomic structures (right neck, SCM clavicle attachments cut and muscle pulled laterally) ¥: posterior belly of digastric muscle, ¶: external jugular vein; #: internal jugular vein; formula image : accessory nerve; thin arrow: trapezial branch of accessory nerve; thick arrow: sternocleidomastoid branch of accessory nerve; *: great auricular nerve; ǂ: cutaneous branches of the cervical plexus nerves; blue arrow: PBD-SCMen
See this image and copyright information in PMC

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