A simple method of identifying the spinal accessory nerve in modified radical neck dissection: anatomic study and clinical implications for resident training.
OBJECTIVE
The major complication of neck dissection and surgery at the posterior triangle of the neck is the shoulder syndrome, which results from spinal accessory nerve injury. Erb's point (the great auricular nerve) and the point where the spinal accessory nerve enters the trapezius muscle are used to identify the spinal accessory nerve in the posterior nerve triangle.


METHODS
Measurements were made during unilateral neck dissections in 30 patients to identify the relationship between the spinal accessory nerve and great auricular nerve and the distance between the entrance of the accessory nerve in the trapezious and clavicle.


RESULTS
The distance between the spinal accessory nerve and Erb's point was ranging from 0 to 3.8 cm (mean 1.53 cm). The distance between the spinal accessory nerve entering the trapezious muscle and the clavicle was between 2.5 and 7.3 cm (mean 4.8 cm).


CONCLUSIONS
Since the great auricular nerve (Erb's point) represents a constantly identifiable landmark, it allows simple and reliable identification of the course of the spinal accessory nerve. Also useful, but of secondary importance in our opinion, is identifying the nerve at the point where it enters the trapezius muscle.
Salgarelli
Attilio Carlo
AC
Oral and Maxillofacial Unit, Head and Neck Dipartiment, Universital Hospital of Modena and Reggio Emilia, Modena, Italy. attiliocarlo.salgarelli@unimore.it
Landini
Barbara
B
Bellini
Pierantonio
P
Multinu
Alessandra
A
Consolo
Ugo
U
Collini
Marco
M
D000055:Accessory Nerve / Q000033:anatomy & histology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002572:Cervical Plexus / Q000033:anatomy & histology; D002968:Clavicle / Q000294:innervation; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009334:Neck Muscles / Q000294:innervation; D013515:Surgery, Oral / Q000193:education*