Superficial landmarks for the spinal accessory nerve within the posterior cervical triangle.
OBJECTIVE
The spinal accessory nerve (SAN) within the posterior cervical triangle (PCT) is the most commonly iatrogenically injured nerve in the body. Nevertheless, there is a paucity of published information regarding superficial landmarks for the SAN in this region. Additional identifiable landmarks of this nerve may assist the surgeon in identifying it for repair, use of it in peripheral nerve neurotization, or avoiding it as in proximal brachial plexus repair. The present study was undertaken to provide reliable superficial landmarks for the identification of the SAN within the PCT.


METHODS
The PCT was dissected in 30 cadaveric sides. Measurements were made between the SAN and surrounding landmarks. The mean distances between the entry site of the SAN into the trapezius and a midpoint of the clavicle, mastoid process, acromion process, and lateral aspect of the sternocleidomastoid (SCM) muscle were 6, 7, 5.5, and 3.5 cm, respectively. The mean distances between the angle of the mandible and the mastoid process and the exit point of the SAN from the posterior border of the SCM muscle were 6 and 5 cm, respectively. The mean width and length of the SAN were 3 and 3.5 cm, respectively.


CONCLUSIONS
It is the authors' hope that these data will aid those who may need to locate or avoid the SAN while undertaking surgery in the PCT and thus decrease morbidity that may follow manipulation of this region.
Tubbs
R Shane
RS
Department of Cell Biology, University of Alabama at Birmingham, USA. rstubbs@uab.edu
Salter
E George
EG
Wellons
John C
JC
Blount
Jeffrey P
JP
Oakes
W Jerry
WJ
D000055:Accessory Nerve / Q000033:anatomy & histology*; D061227:Accessory Nerve Injuries; D000368:Aged; D002102:Cadaver; D002574:Cervical Vertebrae / Q000601:surgery; D003391:Cranial Nerves / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D018482:Muscle, Skeletal / Q000033:anatomy & histology; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000469:parasitology*; D012016:Reference Values