Association of Tortuous Common Carotid Artery with Abnormal Distribution of the Ansa Cervicalis: A Case Report.

In the current study, we display a rare association of an aberrant innervation of the sternocleidomastoid muscle by the ansa cervicalis (AC) with a tortuous common carotid artery (TCCA). In specific, in a male cadaver we observed on the right side of the cervical region, a nerval branch of remarkable size originating from the most distal part of the AC's superior root and after piercing the superior belly of the omohyoid muscle innervated the distal portion of the sternocleidomastoid muscle. Furthermore, we noticed a tortuous course of the initial part of the right common carotid artery. We discuss the surgical significance of the awareness of AC's variations during neurotisation of the recurrent laryngeal nerve in cases of its damage, as well as the importance of aberrant innervation of the sternocleidomastoid muscle by AC for the preservation of muscle's functionality after accessory nerve's damage. Furthermore, we highlight the fact, that the knowledge of the relatively uncommon variant, such as TCCA is crucial for the physician in order to proceed more effectively in differential diagnosis of a palpable mass of the anterior cervical region or deal with symptoms such as dyspnea, dysphagia or symptoms of cerebrovascular insufficiency.

An Anatomic Variant of the Ansa Cervicalis Precluding Its Use as a Donor Nerve.

BACKGROUND: The ansa cervicalis is useful for cranial nerve repair, and may be harvested without apparent morbidity. Herein we report an unusual and surgically relevant anatomic variant of the ansa cervicalis. METHODS: An adult male with left parotid adenoid cystic carcinoma underwent parotidectomy with upper-division facial nerve resection and planned interposition repair using the ansa cervicalis. The ipsilateral hypoglossal nerve was identified, together with a descending branch producing strap muscle contraction when stimulated. This presumed descendens hypoglossi was unusually large in caliber; further dissection revealed continuity with the vagus nerve. RESULTS: Ansa cervicalis harvest was aborted when its separation from vagus nerve epineurium was not possible. The sural nerve was alternatively harvested. The patient awoke with left vocal fold palsy, which completely resolved within 3 months. CONCLUSION: Anatomic variants of the ansa cervicalis exist that may preclude graft harvest and place the vagus nerve at risk of inadvertent injury.

Anastomosis between the transverse cervical nerve and marginal mandibular nerve: how often does it occur?

Anastomoses in the neck between the sensory transverse cervical nerve (C2,3) and the cervical branch of the facial nerve are common, but communications with more superior branches of the facial nerve are rare. After we had identified a case where the transverse cervical nerve joined the marginal mandibular branch of the facial nerve in the submandibular triangle during a selective neck dissection, we searched for this variant in 86 neck dissections to see if it occurs more often than expected. We found it in one further patient. As this anastomosis of the nerve could easily be confused with the marginal mandibular branch itself, particularly during a more limited exposure (such as excision of a submandibular gland), our findings remind surgeons to be vigilant when dissecting in this area to minimise the risk of weakness of the lower lip postoperatively.

Relevance of discrete traits in forensic anthropology: From the first cervical vertebra to the pelvic girdle.

In forensic anthropology, identification begins by determining the sex, age, ancestry and stature of the individuals. Asymptomatic variations present on the skeleton, known as discrete traits, can be useful to identify individuals, or at least contribute to complete their biological profile. We decided to focus our work on the upper part of the skeleton, from the first vertebra to the pelvic girdle, and we chose to present 8 discrete traits (spina bifida occulta, butterfly vertebra, supraclavicular nerve foramen, coracoclavicular joint, os acromiale, suprascapular foramen, manubrium foramen and pubic spine), because they show a frequency lower than 10%. We examined 502 anonymous CT scans from polytraumatized individuals, aged 15 to 65 years, in order to detect the selected discrete traits. Age and sex were known for each subject. Thin sections in the axial, coronal and sagittal planes and 3D volume rendering images were created and examined for the visualization of the selected discrete traits. Supraclavicular foramina were found only in males and only on the left clavicle. Coracoclavicular joints were observed only in males. The majority of individuals with a suprascapular foramen were older than 50 years of age. Pubic spines were observed mostly in females. Other traits did not present significant association with sex, age and laterality. No association between traits was highlighted. Better knowledge of human skeletal variations will help anthropologists come closer to a positive identification, especially if these variations are rare, therefore making them more discriminant.

Unusual morphological pattern and distribution of the ansa cervicalis: a case report.

Ansa cervicalis presents great anatomic variability regarding its origin and formation, the number of its roots and its distribution, as well. In the current case, we report an aberrancy in the form and distribution of ansa cervicalis' branches to the infrahyoid muscles and the sternocleidomastoid muscle, which is unique, since, to the best of our knowledge, a similar case has not been recorded in the literature. During regular dissection, we detected that the ansa cervicalis' loop, which was formed underneath the superior belly of the omohyoid muscle, provided a branch for the sternothyroid muscle, from which two recurrent rami were arisen. These two rami joined together forming an unusual triangular nerve formation. The neural trunk formed by the union of the aforementioned two rami perforated the inferior belly of the omohyoid muscle and afterwards was directed towards the ipsilateral sternocleidomastoid muscle. The awareness of such an unusual variability to the surgeons of the head and neck region would be of great importance, since it is crucial not to damage the ansa cervicalis or its branches in order to prevent any possible phonation disorders. Additionally, ansa cervicalis is proved to be extremely useful in the re-innervation of the larynx following paralysis of the recurrent laryngeal nerve.

Cervical plexus block helps in diagnosis of orofacial pain originating from cervical structures.

Headache associated with cervical lesions is called cervicogenic headache and involves the occiput but not the orofacial region. However, patients occasionally present with orofacial pain accompanied by neck symptoms. This study investigates whether orofacial pain can originate from the neck and whether cervical plexus block can help in diagnosis. We enrolled eight patients suffering from chronic orofacial pain that had not been relieved by dental treatment. Radiographic and magnetic resonance imaging revealed abnormal findings in the neck in seven of them. To identify the origin of the orofacial pain, we firstly blocked peripheral sensory input from the oral cavity and surrounding tissues, followed by that from deep cervical structures. We injected local anesthetics around the painful orofacial region, then to the tender points in the masticatory and superficial cervical muscles (trigger point injection), and consequently around the cervical plexus. Pain was assessed using a pain relief score compared with pre-treatment control values. Local anesthesia in the painful oral region provided insufficient relief whereas trigger point injection significantly relieved pain. The amount of pain relief generated by the deep cervical plexus block was more significant than that produced by any other procedures. We conclude that certain types of orofacial pain originate from cervical structures and that a deep cervical plexus block can be helpful in differentially diagnosing such pain.

Ansa cervicalis as a variant of spinal accessory nerve plexus: a case report.

The ansa cervicalis is a neural loop in the neck formed by the union of two main nerve roots, namely superior and inferior roots, derived from ventral rami of the cervical nerves. With the expanding use of the ansa cervicalis for reinnervation procedures and the fact that it is located in the vicinity of major nerves and vessels of the neck, knowledge of the topography and morphology of this loop is quite necessary in the modern era. Any variation in the course, contributing roots or branching pattern of the ansa cervicalis, potentially alters and perhaps complicates the course of the procedures involving this nerve such as neurorrhaphy, skull base surgery, neck dissection, and anterior cervical spinal approach. Here, we present an unusual case of an ansa cervicalis encountered upon routine dissection of an adult male cadaver. In this case, the inferior root of the ansa cervicalis was formed by the joining of two rootlets, one originating from spinal accessory nerve and the other from a branch of the cervical plexus to the sternocleidomastoid muscle. The fibers traversing the branch of spinal accessory nerve were derived from the first segments of the cervical spinal cord. This case demonstrates a variant of the spinal accessory nerve plexus that contributed to the formation of the ansa cervicalis. Review of the literature was performed to reveal the possible clinical aspects of this anatomical variation.

Anomaly of the supraclavicular nerve: case report and review of the literature.

We report a male cadaver found to have his right intermediate branch of the supraclavicular nerve piercing the clavicle. No other anomalies were found in this specimen. Following a review of the literature, it appears that symptoms related to this finding are rare but do occur most commonly involving the intermediate branch of the supraclavicular nerve. Symptoms may be alleviated with surgical decompression of the entrapped nerve. Although rare, the clinician should include entrapment of the supraclavicular nerve within the clavicle in their differential diagnosis of shoulder pain.

Bilateral absence of ansa cervicalis replaced by vagocervical plexus: case report and literature review.

The bilateral absence of the ansa cervicalis was discovered during dissection of the neck in an elderly male cadaver. On both sides it was replaced by a vagocervical plexus formed by the vagus nerve and C1 and C2 ventral rami from the cervical plexus. A descending branch from this vagocervical plexus supplied the strap muscles of the neck. From a review of the literature the incidence of bilateral absence of the ansa cervicalis and its replacement by a vagocervical plexus appears to be extremely rare. Morphological variability, embryological basis, and clinical relevance of this uncommon anatomical variant are discussed.

Congenital dilation of the cervical epidural venous plexus: neuroradiology and endovenous management.

We report a case of a 15-year-old girl suffering from cervicobrachialgia who was admitted to our service due to an enlarged neural foramen suspicious for a neurinoma. The cervical phlebography, however, revealed a space-occupying dilated epidural vein with increased blood supply from the suboccipital venous plexus. Lesions like this are absolutely rare, presumably of congenital origin and have not been described before. The lesion was treated by feeder occlusion applying platinum coils and enbucrilate via the internal jugular vein.

The intradural cervical plexus. An absent cervical nerve root.

Whilst dissecting the intradural and peripheral pathways of the spinal accessory n. (Sp. XI) as part of a larger study into its microsurgical anatomy, we have discovered an unusual and previously unreported anatomical variant. In one cadaver the intradural C2 dorsal n. root was completely absent on the left side. Considerable speculation surrounds the function of the spinal accessory n. in human subjects. Recent anatomical and clinical studies have drawn attention to the intradural plexus-like morphology of the Sp. XI and raised the possibility of integration of pro-prioception and motor control of the neck musculature at this level. The general anatomy of the Sp. XI is reviewed along with current ideas from recent studies.

Vagocervical complex replacing an absent ansa cervicalis.

Absence of the ansa cervicalis was noticed in only one out of 200 cadavers, and that only on the right side, where it was replaced by the vagocervical complex. This complex was formed by the vagus nerve with the C1 and C2 components from the cervical plexus, giving off a descending branch to supply the infrahyoid muscles of the neck.

[Supraclavicular nerves perforating the clavicle. Study of 10 cases]. / Nerfs supraclaviculaires perforant la clavicule Etude sur 10 cas.

The present study concerns a report on the observations of supraclavicular nerves with abnormal passage though one or several intraclavicular bone canals. The explanation of the formation of interclavicular canals is found by the normal development of the clavicle. In most of the cases the bone canals are situated in the central part of the clavicule and rarely at the acromial end. The canals are either superficial or deep. Often bone bridges are formed. The bone canals and the supraclavicular nerves are barely visible on X-ray photographs. Polarising microscope analysis shows that the intraclavicular canals do not have the structure of the perforating canals of Volkmann. It can be deduced that the supraclavicular nerves have not pierced the bone substance already formed but, that they have been enclosed during later bone formation. Of the 254 cases studied (189 male and 65 female) the incidence of the described abnormality was 4% (10 cases) of which 3% were male.