title: Anatomy and blood supply of the lower four cranial and cervical nerves: relevance to surgical neck dissection.
abstract: This study is a continuation of previous work searching for possible anatomic reasons to explain variable and usually unpredictable postoperative pain and dysfunction after the same nerve losses with similar neck dissection operations. The study consisted of dissections of 19 deceased unpreserved elderly subjects arterially injected with dyed latex. Of the 19 subjects, 14 had brain stem and cervical spinal cord dissections, and all had neck dissections. The findings suggested two possible anatomic reasons for the pain and dysfunction: (i) The intracranial anatomy of the lower four cranial nerves, the glossopharyngeal (IX), the vagus (X), the spinal accessory (XI), and the hypoglossal (XII), was just as variable as the previously reported peripheral spinal accessory nerve plexus; and (ii) Both the intracranial and neck dissections indicated that the blood supply to the lower four cranial and cervical nerves, particularly to the brachial plexus, could be impaired by atherosclerosis and/or neuroforaminal impingement or operative loss. This loss of blood supply theoretically could result in ischemia as another possible cause of postoperative pain and dysfunction. It is concluded that because of the potential importance of each nerve and vessel, often unknown at operation, it is very important to spare as many of them as possible to avoid subsequent painful impairment.
authors.affiliation: The Harvard School of Medicine, The Departments of Anatomy and Plastic Surgery and The Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: H
authors.initials: H
authors.lastname: Brown
authors.forename: G
authors.initials: G
authors.lastname: Hidden
authors.forename: M
authors.initials: M
authors.lastname: Ledroux
authors.forename: L
authors.initials: L
authors.lastname: Poitevan
mesh_terms: D000055:Accessory Nerve / Q000033:anatomy & histology / Q000098:blood supply; D001917:Brachial Plexus / Q000033:anatomy & histology / Q000098:blood supply; D002339:Carotid Arteries / Q000033:anatomy & histology; D003391:Cranial Nerves / Q000033:anatomy & histology* / Q000098:blood supply*; D004210:Dissection; D005930:Glossopharyngeal Nerve / Q000033:anatomy & histology / Q000098:blood supply; D006801:Humans; D007002:Hypoglossal Nerve / Q000033:anatomy & histology / Q000098:blood supply; D009333:Neck / Q000601:surgery*; D010146:Pain; D011183:Postoperative Complications; D013127:Spinal Nerves / Q000033:anatomy & histology* / Q000098:blood supply*; D013348:Subclavian Artery / Q000033:anatomy & histology; D014630:Vagus Nerve / Q000033:anatomy & histology / Q000098:blood supply; D014711:Vertebral Artery / Q000033:anatomy & histology