Objective To further clarify the anatomical features of the long occipital nerve and summarize the rapid anatomical method for it,thus providing an operational basis for anatomists.Methods The bilateral sides of the head and neck specimens of 38 adult formalin-fixed cadavers were dissected,with a total of 76 specimens.The lateral cervical region,the sternocleidomastoid region,and the occipital region were dissected.The dissection focused on the long occipital nerve,the location and adjacent structural characteristics of which were carefully observed.Results The long occipital nerve was dissected out from 76 specimens.Through the posterior margin line(PML)anatomical method,the long occipital nerve was identified 1-3 cm above the accessory nerve,near the posterior border of the deep surface of the upper sternocleidomastoid in 70(92.1%)specimens.Through the inflection point(IP)anatomical method,the long occipital nerve was observed within the range of the circle with a radius of about 1.5 cm and centered on the midpoint of the line between the tip of the mastoid process and the tip of the external occipital protuberance in 6(7.9%)specimens.Conclusions The long occipital nerve can be quickly found by the PML method or IP method.Although the long occipital nerve can definitely be identified by the IP method,the anatomical operation is difficult.
Humans ; Cadaver ; Spinal Nerves/anatomy & histology* ; Neck/innervation* ; Adult

OBJECTIVETo investigate the incidence of C5 nerve root palsy after multi-segmental cervical decompression through different approaches.

METHODSThis study was conducted among 375 patients undergoing multi-segmental cervical decompression in anterior corpectomy and fusion fixation, anterior cervical corpectomy and fusion fixation + posterior decompression and fusion fixation, posterior cervical laminectomy decompression, fusion and internal fixation, and posterior laminoplasty and fusion groups. The exclusion criteria included lack of follow-up data, spinal cord injury preventing preoperative or postoperative motor testing, or surgery not involving the C5 level. The incidence of C5 palsy was determined and the potential risk factors C5 palsy were analyzed including age, sex, revision surgery, preoperative weakness, diabetes, smoking, number of levels decompressed, and a history of previous upper extremity surgery.

RESULTSOf the 375 patients, 60 patients were excluded and the data of 315 patients were analyzed, including 146 women and 169 men with a mean age of 57.7 years (range 39-72 years). The overall incidence of C5 nerve palsy was 6.03% (19/315) in these patients; in the subgroups receiving different surgeries, the incidence was 8.62% in the cervical road laminectomy and fusion fixation group, 7.79% in the anterior cervical corpectomy and fusion fixation + posterior decompression and fusion and internal fixation, 4.68% in the anterior corpectomy and fusion fixation group, and 3.85% in the posterior laminoplasty and fusion group. No significant difference was found in the incidences among the subgroups, but men were more likely than women to develop cervical nerve root palsy (8.28% vs 3.42%, P<0.05).

CONCLUSIONThe overall incidence of C5 nerve palsy following postoperative cervical spinal decompression was 6.03% in our cohort. The incidence of C5 nerve palsy did not differ significantly following different cervical decompression surgeries, but the incidence was the highest in the posterior cervical laminectomy and fusion and internal fixation group.

Adult ; Aged ; Cervical Vertebrae ; innervation ; Decompression, Surgical ; adverse effects ; Female ; Fracture Fixation, Internal ; Humans ; Incidence ; Laminectomy ; adverse effects ; Male ; Middle Aged ; Neck ; Paralysis ; pathology ; Risk Factors ; Spinal Nerve Roots ; physiopathology

INTRODUCTIONThe lingual, inferior alveolar and auriculotemporal nerves, being branches of the posterior division of the mandibular nerve, mainly innervate the mandibular teeth and all the major salivary glands. Anomalous communications among these branches are widely reported due to their significance to various treatment procedures undertaken in the region. This study was performed as detailed exploration of the functional perspectives of such communicating branches would further enhance the scope of these procedures.

METHODSA total of 36 specimens were dissected to examine the infratemporal region. The branches from the posterior division of the mandibular nerve--namely the lingual, inferior alveolar and auriculotemporal nerves--were carefully dissected, and their branches were studied and analysed for abnormal course.

RESULTSCommunication between branches of the posterior division of the mandibular nerve was observed in four specimens. In two of the four specimens, communication between the mylohyoid and lingual nerves was observed. A rare and seldom reported type of communication between the auriculotemporal and inferior alveolar nerves is described in this study. This communicating nerve split into two to form a buttonhole for the passage of the mylohyoid nerve.

CONCLUSIONSuch communicating branches between nerves found in this study are developmental in origin and thought to maintain functional integrity through an alternative route.

Cadaver ; Female ; Humans ; Lingual Nerve ; anatomy & histology ; Male ; Mandibular Nerve ; anatomy & histology ; Neck Muscles ; innervation ; Tongue

OBJECTIVE: To explore the clinical anatomy of vagal schwannoma and the methods to preserve the continuity of vagus nerve during tumor resection and postoperative functional rehabilitation methods of the nerve. METHOD: To review 15 cases of vagal schwannoma from 2002.07 to 2011.08 treated in the Department of Otolaryngology, West China Hospital. The operative modality was to strip the tumor while keeping the Schwann membrane almost intact so that to protect the nerve fibers as much as possible. postoperative treatment included glucocorticoids, neurotrophic medication, as well as voice and swallowing rehabilitation. RESULT: Among 15 cases of schwannoma patients, 3 cases (3/15) experienced hoarseness of voice with the ipsilateral vocal cord located at the median position 2 years after operation. 2 cases(2/15) experienced no obvious hoarseness of voice with vocal cords slight vibration when pronouncing and reached normal vocal cord movement 3 months after operation, 10 cases were healed without vocal cord complications, 7 cases (7/15) experienced choking during drinking and the symptom was gradually eliminated 1 3 months thereafter. CONCLUSION To carefully discern and preserve the vagal fibers during the operation of vagal schwannoma could eliminate postoperative hoarseness and choking. Protection of superior laryngeal nerve should be also brought to the forefront because it could affect the quality of swallowing and speaking.
Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Neck ; innervation ; Neurilemmoma ; surgery ; Retrospective Studies ; Vagus Nerve ; surgery ; Vocal Cords ; Voice Quality ; Young Adult

PURPOSE: We hypothesized that comprehensive neck dissection could be achieved via a gasless transaxillary approach using a robotic system. We intended to evaluate the accessibility of level I, IIB and VA nodes with transaxillary robot-assisted neck dissection of four cadavers. MATERIALS AND METHODS: Transaxillary robotic neck dissection was performed in four cadavers through a 7-cm longitudinal incision at the anterior axilla and a 0.8-cm-sized incision in the chest wall. RESULTS: We successfully performed neck dissection from level II to V in all four cadavers. However, dissection of levels IIB and VA, which lie on the cephalic portion of the spinal accessory nerve, was difficult. Vital structures, including the internal jugular vein, carotid artery, vagus nerve, phrenic nerve, superior thyroid artery and hypoglossal nerve, were successfully identified and preserved. CONCLUSION: Our results demonstrate the feasibility of robot-assisted neck dissection using a transaxillary approach. We suggest that gasless, transaxillary robotic neck dissection is a promising technique for treating nodal metastasis in thyroid cancers or in selected squamous cell carcinomas of the head and neck. However, some modification of the approach might be needed when performing comprehensive neck dissections of all levels of the neck.
Cadaver ; Endoscopy/instrumentation/methods ; Feasibility Studies ; Female ; Head and Neck Neoplasms/*surgery ; Humans ; Male ; Neck/blood supply/innervation/surgery ; Neck Dissection/*instrumentation/*methods ; Neoplasms, Squamous Cell/*surgery ; Robotics/*methods ; Thyroid Neoplasms/*surgery

OBJECTIVE: To explore the clinical prognosis of sublingual nerve anastomosis with a branch of the deep cervical nerves or accessory nerve. METHOD: To retrospectively analyze 2 cases of paraganglion tumor,in which the sublingual nerve were disconnected because of overdrawing of surrounding tissue and tumor invasion. One branch of deep cervical nerve or accessory nerve was dissected and anastomosed to the distal end of sublingual nerve. Steroids and nerve nutritional chemicals were given after operation, and early functional physical exercise was recommended for the two patients. RESULT: The lingual mobility of the two patients was restored partially 1 to 2 months after operation, while the tongue of lesion side suffered from slight atrophy especially in the posterior 1/2 part. The patients experienced better and better mobility of the tongue. CONCLUSION Sublingual nerve anastomosis with a branch of the deep cervical nerves or accessory nerve is viable. It could be a reconstructive modality for patients suffered from sublingual nerve disconnected.
Accessory Nerve ; surgery ; Adult ; Anastomosis, Surgical ; Cervical Plexus ; surgery ; Female ; Head and Neck Neoplasms ; surgery ; Humans ; Hypoglossal Nerve ; surgery ; Middle Aged ; Neck ; innervation ; Neurosurgical Procedures ; methods ; Paraganglioma ; surgery ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo study the neurophysiologic of detrusor overactivity (DO) due to partial bladder outflow obstruction (PBOO).

METHODSTwenty four female Wistar rats with DO caused by PBOO were studied simultaneously with ten sham-operated rats. An electrophysiological multi-channel simultaneous recording system was used to record pelvic afferent fiber potentials as well as the pudendal nerve motor branch potentials, external urethral sphincter electromyogram (EUS EMG) and abdominal muscle EMG during filling cystometry. To test the effect of the unstable contraction in DO rats after the decentralization of the central nervous system, DO rats were studied the changes of the unstable contraction after transection of the spinal cord (T(8) level), pelvic nerve, the sympathetic trunk, and the pudendal nerve.

RESULTSThe incidence of DO was 62.5% in filling cystometry. During filling cystometry, there are two type of DO contraction according to the changes of pelvic afferent fiber signals, the relevant nerves and muscles responses: the small pressure of the unstable contraction (S-DO) and the big pressure of the unstable contraction (B-DO). For the B-DO, there were significant changes in the recordings of pelvic afferent fiber, the motor branch of the pudendal nerve, EUS EMG, and abdominal muscle EMG. While all these differences have not been recorded during S-DO. Both the filling-voiding cycle and the unstable contraction of B-DO were eliminated and the base line of bladder pressure increased after T(8) spinal cord transection. While the S-DO was not affected by such transection. When bladder relevant nerves were transected by the sequence of the pelvic nerve, the sympathetic trunk, and the pudendal nerve, the filling-voiding cycle was eliminated. The base line of bladder pressure increased significantly. No B-DO was recorded, but the S-DO still existed.

CONCLUSIONThere are some bladder-genic factors take part in the DO contractions induced by PBOO.

Animals ; Disease Models, Animal ; Female ; Pelvic Floor ; innervation ; Rats ; Rats, Wistar ; Urinary Bladder ; innervation ; Urinary Bladder Neck Obstruction ; complications ; physiopathology ; Urinary Bladder, Overactive ; etiology ; physiopathology

OBJECTIVETo describe a new method of accessory nerve defect reconstruction with sternocleidomastoid muscle-great auricular flap.

METHODSThirty-four cases receiving traditional radical neck dissection were divided into two groups: single neck dissection group (n = 19) and accessory nerve reconstruction group (n = 15). Surgical procedure of the reconstruction was described in detail. Postoperative shoulder functions were compared between the two groups.

RESULTSAccessory nerve reconstruction group experienced much better shoulder function recovery than that in single neck dissection group.

CONCLUSIONSReconstruction of accessory nerve defects with sternocleidomastoid muscle-great auricular nerve flap is simple, effective and complication-free.

Accessory Nerve ; surgery ; Accessory Nerve Injuries ; Adult ; Aged ; Carcinoma, Squamous Cell ; secondary ; surgery ; Ear ; innervation ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Mouth Neoplasms ; pathology ; surgery ; Neck ; Neck Dissection ; methods ; Neck Muscles ; surgery ; Nerve Transfer ; methods ; Surgical Flaps ; Treatment Outcome

OBJECTIVETo study a new method for repair of facial depression and facial nerve defect after parotid carcinoma resection.

METHODS12 patients with parotid carcinoma and peripheral bone invasion were treated using facial nerve canal dissection and radical resection of the tumor, the parotid gland and the involved facial nerve and bone, including the mastoid, stylomastoid foramen, styloid process and the rear part of the mandible. A sternocleidomastoid muscle flap was elevated and transferred to repair the facial depression. The great annular nerve in the flap was anastomosed with the severed end of the facial nerve in the canal.

RESULTSThe depressed deformity of the parotid area was well corrected in 9 patients. The aesthetic results were compromised in 2 patients because of tumor recurrence and reoperation. The depressed deformity was not corrected in 1 patient because of infection. Postoperatively, the function of the facial nerve recovered to a normal level. The recovery time ranged from 12 to 20 weeks ,with an average of 16.3 weeks. The local control rate of tumor was improved.

CONCLUSIONSImmediate transplantation of the sternocleidomastoid muscle-great auricular nerve flap and facial nerve canal dissection in radical parotidectomy can repair the depressed deformity of the parotid area, restore facial nerve function,and decrease tumor recurrence. The method is an ideal operation with functional recovery.

Adult ; Cervical Plexus ; Facial Nerve ; transplantation ; Female ; Humans ; Male ; Middle Aged ; Neck Muscles ; transplantation ; Parotid Neoplasms ; surgery ; Surgical Flaps ; innervation ; Treatment Outcome

OBJECTIVEThe surgical anatomy and preservation of the accessory nerve in radical functional neck dissection were studied.

METHODSThirty-three cN(0) patients with oral cancers were entered into the study. Radical functional neck dissection were performed and the relations between the accessory nerve and its surrounding structures were recorded.

RESULTSThe accessory nerve going through or beneath the sternocleidomastoid muscle occurred in 82% (27/33) and 18% (6/33) of the patients respectively. Communicating branches between the accessory and the cervical nerves were found in 85% (28/33). There was 2 to 3 cm of the accessory nerve paralleled to the anterior border of the trapezius muscle before it entered the muscle in 70% (23/33). The dissection of the nerve needed 20 to 30 minutes. Twenty-seven percent of the patients had pathologically proved lymph node metastases.

CONCLUSIONSLooking for accessory nerve under the upper portion of the sternocleidomastoid muscle and above the middle point of the muscle posterior border is simple and safe. The point of the great auricular nerve going out the muscle is an important indicator for finding the accessory nerve.

Accessory Nerve ; pathology ; physiopathology ; Adult ; Aged ; Carcinoma, Squamous Cell ; surgery ; Female ; Humans ; Male ; Middle Aged ; Mouth Neoplasms ; surgery ; Neck Dissection ; methods ; Neck Muscles ; innervation