A Rare Case Of Bilateral Variant Ansa Cervicalis And Review Of Literature

Ansa cervicalis is a nerve loop that is embedded in the anterior wall of carotid sheath of the neck. It is formed bydescendent hypoglossi and descendens cervicalis. It supplies the infrahyoid muscles. During routine dissection,a rare variant in the morphology of Ansa cervicalis was observed in adult male cadaver. The variant ansacervicalis exhibited two loops, and was present bilaterally. The formation, course and relations of the nerve loopis complex. During literature search, we came across studies which propose different classifications. Hence wehave added a note on the different classifications.Ansa cervicalis is important since it can be used in nerve-nerve anastomosis, nerve-muscle pedicle implantationin relation to reconstructive surgeries of larynx. Hence, the knowledge of variations in the formation, anddistribution is relevant. It can affect the outcome during reinnervation surgeries following recurrent laryngealparalysis and surgeries around this area of neck.

Comparison of the quality of life between patients underwent reconstruction after hemiglossectomy using infrahyoid myocutaneous flap and radial forearm flap / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVEThis study was designed to compare the quality of life between patients who underwent a tongue reconstruction with radial forearm flap (RFF) and infrahyoid myocutaneous flap (IHMCF) after hemiglossectomy for their tongue cancers, and to figure out an optimal reconstructive method for the defects resulted from hemiglossectomy.METHODSA non-randomized case-control study was performed on 24 patients with tongue squamous cell carcinoma who underwent a standard hemiglossectomy combined with perfectly tongue reconstruction from June 2005 to June 2012. All of the cases were without tongue base invasion. Of the 24 cases, 19 had T2 disease, 5 had T3 disease, and they were divided into RFF group (n=10) and IHMCF group (n=14). The quality of life were evaluated one year after operation using EORTC-QLQ30 and FACT-H&N35 and compared between the two groups.RESULTSThe scores were comparable between the two group with regard to all domains of EORTC-QLQ30,with all P values>0.05.The scores of swallowing(P=0.005), speech (P=0.008), teeth (P=0.014), and cough (P=0.009) domains were significantly higher in IHMCF group than in RFF group, with P value of 0.005, 0.008, 0.014 and 0.009 respectively, while the other domains of FACT-H&N35 were comparable between the two groups, with allP values>0.05.CONCLUSIONOverall quality of life was similar in the two groups. Oral function domains were better in IHMCF group than in RFF group. When guarantee of flap survival is available, IHMCF could be used as a good alternative flap to RFF in tongue reconstruction after hemiglossectomy.

Unilateral Absence of the Sternohyoid Muscle with Contralateral Tendinous Belly of Superior Belly of Omohyoid Muscle: A Very Rare form of Infrahyoid Muscle Variation.

The sternohyoid, sternothyroid, thyrohyid and omohyoid constitute the infrahyoid group of anterior neck muscles. All these muscles are supplied by Ansa crvicalis related to the anterior wall of carotid sheath. During regular cadaveric dissection in the Department of Anatomy at AIIMS, Bhubaneswar, a case of right sided absence of sternohyoid muscle with left sided tendinous superior belly of omohyoid muscle was found. Though literature survey shows the tendinous belly (or absence) of superior belly of omohyoid muscle, but its presence in combination with absence of opposite side sternohyoid muscle is hardly reported. The omohyoid muscle has effect on intracerebral venous hemodynamics. Developing from a common muscle primodium the infrahyoid muscle group shows a number of variations. Because of increased use of Infrahyoid myocutaneous flaps for medium sized head and neck reconstruction surgery this knowledge will be helpful for handling and selecting a flap.

Anatomical variations in the Ansa cervicalis and innervation of infrahyoid muscles.

Background: – Infrahyoid muscles are supplied by the ansa cervicalis. The present study aimed to study the variations in the ansa cervicalis and the innervation of infrahyoid muscles. Methods: The study was conducted on 40 cadaveric hemi-necks. Results: Out of the 40 hemi-necks, high level of ansa cervicalis was observed in 2 hemi-necks, intermediate level of ansa was observed in 35 hemi-necks and low level of ansa was observed in 3 hemi-necks. Additionally, dual ansa with absence of inferior root was seen in 4 hemi-necks, dual ansa with absence of inferior root and inter-communication between C2 and C3 was seen in 2 hemi-necks, common trunk supplying all infrahyoid muscles including superior belly of omohyoid was seen in 2 hemi-necks, nerve to inferior belly of omohyoid from inferior root was seen on 1 side. In one specimen unilaterally, superior belly of omohyoid was innervated by a branch from hypoglossal nerve, two superior roots arising from hypoglossal nerve and the inferior root formed only by C3 was seen in the same specimen. Discussion: The knowledge of the possible variations of ansa in relation to the great vessels of the neck prevents the inadvertent injury to those vessels. Any injury can result to phonation disability in professional voice users. In case of infrahyoid muscles palsy, patients have no serious voice problems in their normal speech but the pitch of their voice and also prosody in their singing are lost dramatically. Conclusion: These variations are of clinical importance for the reconstructive surgeries which involve the infrahyoid muscles.

Application of infrahyoid myocutaneous flap in the reconstruction for early stage mouth floor carcinoma / 中华显微外科杂志

ObjectiveTo evaluate the clinical value of infrahyoid myocutaneous flap in the reconstruction of mouth floor tissue defects. MethodsInfrahyoid myocutaneous flap was made including stenohyoid,thyrohyoid,omohyoid and the affiliated skin based on the axis of superior thyroid artery,vein and ansa cervicalis. The clinical data of 11 patients with reconstruction of mouth floor tissue defects using infrahyoid myocutaneous flap (maximum area was 8 cm × 3 cm) from Match 1993 to June 2009 were retrospectively reviewed.ResultsSeven infrahyoid myocutaneous flaps which reserved platysma branch of superior thyroid artery were all alive, while 2 patients presented epidermal necrosis of 4 un-protected patients. The follow-up period was range from 24 months to 195 months, one patient received salvage surgery for local regional lymphatic recurrence in level Ⅰ,which survived without diseases until now.The rest cases had turned out a success.No dysphagia,dysphonia,and tongue extension difficulty was reported in any patient.ConclusionInfrahyoid myocutaneous flap is one of the valuable donor sites for the reconstruction of mouth floor tissue defects after radical oncologic operations,especially for those with early stage carcinoma of the mouth floor.

Variation of the Infrahyoid Muscle: Duplicated Omohyoid and Appearance of the Levator Glandulae Thyroideae Muscles

The embryologic origin of the omohyoid muscle is different from that of the other neck muscles. A number of variations such as the absence of muscle, variable sites of origin and insertion, and multiple bellies have been reported. However, variations in the inferior belly of the omohyoid muscle are rare. There have been no reports of the combined occurrence of the omohyoid muscle variation with the appearance of the levator glandulase thyroideae muscle. Routine dissection of a 51-year-old female cadaver revealed a duplicated omohyoid muscle and the appearance of the levator glandulae thyroideae muscle. In this case, the two inferior bellies of the omohyoid muscle were found to originate inferiorly from the superior border of the scapula. One of the inferior bellies generally continued to the superior belly with the tendinous intersection. The other inferior belly continued into the sternohyoid muscle without the tendinous intersection. In this case, the levator glandulae thyroideae muscle appeared on the left side, which attached from the upper border of the thyroid gland to the inferior border of the thyroid cartilage. These variations are significant for clinicians during endoscopic diagnosis and surgery because of the arterial and nervous damage due to iatrogenic injuries. The embryologic origins of the omohyoid and levator glandulae thyroideae muscles may be similar based on the descriptions in the relevant literature.

Appearance of the Cleidohyoideus Muscle Combined with the Multiple Variations of the Infrahyoid Muscle / 대한해부학회지

Multiple variations of the infrahyoid muscle combined with appearance of cleidohyoideus muscle were found in a Korean male cadaver (age : 82) in a routine dissection. In this case, the hyoid bone descended to the level of the upper half of the thyroid cartilage. Then, the mylohyoid, stylohyoid and geniohyoid muscles, which attach to the hyoid bone, descended to the same level. An unusual cleidohyoideus muscle attached from the superior border of the medial third of the clavicle to the hyoid bone was observed bilaterally at the superficial layer. At deeper layer, the sternohyoid muscle, which was additionally attached to the first rib as well as sternum and clavicular head, appeared bilaterally. In the same layer, the left omohyoid muscle was partially merged to the muscle mass of sternohyoid and attached to the hyoid bone. In the deepest layer, the sternothyroid muscle was attached to the medial half of the first rib. The nerves that innervated this infrahyoid muscle originated from the cervical plexus, devoid of the ansa cervicalis.

A study of anatomical variability of the omohyoid muscle and its clinical relevance

OBJECTIVE: The omohyoid muscle is a long, thin muscle consisting of superior and inferior bellies and an intermediate tendon, which runs obliquely in the lateral cervical region. The omohyoid is important in neck dissections because it is the surgical landmark for level III and IV lymph node metastases. METHODS: In the present study, the anterior and posterior triangle of the neck was dissected in 35 male cadavers and observed for variations in the omohyoid bilaterally. Observations were focused on variations in number, attachments, and position of omohyoid. RESULTS: Among the 35 cadavers studied, double omohyoid was present in one cadaver, inferior belly originated from the clavicle in three cadavers, superior belly merged with the sternohyoid in two cadavers, and the omohyoid received additional slips from the sternum in one cadaver. Standard attachment and position of the omohyoid was observed in the remaining cadavers. CONCLUSION: Variations of this muscle are important because of its close relation to the large vessels and brachial plexus. Because of the direct adhesion of the intermediate tendon to the anterior wall of the internal jugular vein and its connection with it through a thin lamina of the pretracheal layer of the cervical fascia, the contraction of the omohyoid muscle has a direct effect on the lumen of this vessel.

Genial Advancement, Infrahyoid Myotomy and Suspension in Treatment of Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome(OSAS) is a complex sleep disorder characterized by intermittent apnea secondary to sleep-induced obstruction of the upper airway. It occurs because of an airway obstruction anywhere between the trachea and the oronasal apparatus. The hallmark of OSAS is snoring, which is caused by vibration of the tissues of the pharynx as the airway narrows. The consequences of OSAS have focused on excessive daytime sleepiness resulting from sleep fragmentation and the cardiovascular derangements producing hypertension and arrhythmias. The primary method of controlling OSAS has been surgery. The current surgical procedures used for OSAS are tracheostomy, tonsillectomy, nasal septoplasty, uvulopalatopharyngoplasty, anterior mandibular osteotomy with hyoid myotomy and suspension, and maxillary, mandibular and hyoid advancement. We report a case of OSAS that was improved by genial advancement with infrahyoid myotomy and suspension. The patient was objectively documented by polysomnography, cephalometric analysis, and physical examination before the surgical procedure. The patient underwent genial advancement with infrahyoid myotomy and suspension. Patient had a good response from surgery.

Total lower lip and chin reconstruction with the infrahyoid musculocutaneous flap.

A composite resection of total lip, chin and part of the mandible creates a defect that challenges the capability for reconstruction to obtain an acceptable result, both functionally and aesthetically. We have successfully used the infrahyoid musculocutaneous flap to reconstruct such a defect in a patient who had basal cell carcinoma of the low lip. Since the flap is pliable, relatively thin and can be used to reconstruct the defect in one stage, it deserves consideration as one of the flaps of choice for this particular defect.