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. 2025 Aug;282(8):4251-4258.
doi: 10.1007/s00405-025-09393-x. Epub 2025 May 14.

A novel method of finding accessory nerve during head and neck surgery

G Ozyigit  1 , H B Cobanoğlu  2 , S Arslan  1 , A F Ozyasar  3 , O Bahadır  1 , A U Isik  1
Affiliations

A novel method of finding accessory nerve during head and neck surgery

G Ozyigit et al. Eur Arch Otorhinolaryngol. 2025 Aug.

Abstract

Introduction and purpose: In this prospective study, we performed neck morphological measurements and the relationship between the nerve and important anatomical structures in the neck to prevent spinal accessory nerve (SAN) damage in patients who underwent neck dissection.

Methods: This study was conducted prospectively between October 2021 and September 2023 in 80 patients who underwent neck dissection due to head and neck malignancy.

Results: The mean age of 59.2 ± 17.07 years (18-90 years) of the 80 patients, 54 were men and 26 were women. There was a positive correlation between the distance between the NAM-SAN and the sternocleidomastoid (Scm) muscle thickness(r = 0.242, p = 0.03). There was a positive correlation between the distance between the NAM-SAN and the distance between the mastoid apex and the clavicle midline (r = 0.235, p = 0.036). There was a statistically significant negative correlation between the distance between the NAM-SAN and age (r = - 0.324 p = 0.003). There was a positive correlation between the trapezius-SAN and the distance between the mandibula angulus-clavicle midline (r = -0.243 p = 0.03).

Conclusion: The spinal accessory nerve must be sought for higher than the estimated point In patients which with more scm thickness. It should be considered that as the preoperatively measured mastoid apex-clavicle distance increases, the distance between the NAM and the SAN increases. It should be taken into consideration that the course of the SAN in the posterior triangle will be longer in patients with longer necks. It should be noted that as age increases, the distance between the SAN and NAM decreases.

Keywords: Great auricular nerve; Neck dissection; Spinal accessory nerve; Surgical anatomy.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no competing interests to declare relevant to this article’s content. Ethical approval: This study was performed in accordance with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University B (2021/281).

Figures

Fig. 1
Fig. 1
Preoperative measurements; a neck circumference from thyroid notch level b distance between mandibula angulus—clavicle midline c distance between mastoid apex and clavicle midline line d distance between the mentum and prominentia laryngea e distance between the prominentia laryngea and incisura jugularis
Fig. 2
Fig. 2
İntraoperative measurements; a Distance between mastoid apex origosus and clavicle insertion of Scm muscle, b Scm thickness at the point where the SAN exits at the posterior border of the Scm muscle, c Scm circumference at the point where the SAN exits at the posterior border of the Scm muscle, d At the posterior border of the Scm muscle The distance between the n.auricular magnus (NAM) and the SAN at the point where the SAN exits e The distance between the SAN and the thyroid notch at the point where the SAN exits at the posterior border of the Scm muscle, f The distance between the SAN and the nerve entering the trapezius muscle at the point where the SAN exits at the posterior border of the Scm muscle, g, h The distance between the point where the SAN exits the posterior-inferior part of the digastric muscle and enters the trapezius muscle
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References

    1. McGarvey AC, Hoffman GR, Osmotherly PG, Chiarelli PE (2014) Intra-operative monitoring of the spinal accessory nerve: a systematic review. J Laryngol Otol 128(9):746–751. 10.1017/S0022215113002934. (Epub 2014 Aug 29 PMID: 25170992) - PubMed
    1. Bertelli JA, Ghizoni MF (2011) Combined injury of the accessory nerve and brachial plexus. Neurosurgery 68(2):390–395. 10.1227/NEU.0b013e318201d7d9. (discussion 396, PMID: 21135731) - PubMed
    1. Lloyd S (2007) Accessory nerve: anatomy and surgical identification. J Laryngol Otol 121(12):1118–1125. 10.1017/S0022215107000461. (Epub 2007 Sep 25 PMID: 17892604) - PubMed
    1. Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, Som P, Wolf GT, American Head and Neck Society; American Academy of Otolaryngology--Head and Neck Surgery (2002) Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg. 128(7):751–758. 10.1001/archotol.128.7.751. (PMID: 12117328) - PubMed
    1. Schuller DE, Saunders WH, Miglets AW, Kelly DR (1981) Conservative neck dissection. Radical approach? Arch Otolaryngol 107(10):642–645. 10.1001/archotol.1981.00790460054017. (PMID: 7283832) - PubMed

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