title: A simple method of identifying the spinal accessory nerve in modified radical neck dissection: anatomic study and clinical implications for resident training.
abstract: 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.
authors.affiliation: Oral and Maxillofacial Unit, Head and Neck Dipartiment, Universital Hospital of Modena and Reggio Emilia, Modena, Italy. attiliocarlo.salgarelli@unimore.it
authors.forename: Attilio Carlo
authors.initials: AC
authors.lastname: Salgarelli
authors.forename: Barbara
authors.initials: B
authors.lastname: Landini
authors.forename: Pierantonio
authors.initials: P
authors.lastname: Bellini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Multinu
authors.forename: Ugo
authors.initials: U
authors.lastname: Consolo
authors.forename: Marco
authors.initials: M
authors.lastname: Collini
mesh_terms: 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*