title: The subdiaphragmatic part of the phrenic nerve - morphometry and connections to autonomic ganglia.
abstract: Few anatomical textbooks offer much information concerning the anatomy and distribution of the phrenic nerve inferior to the diaphragm. The aim of this study was to identify the subdiaphragmatic distribution of the phrenic nerve, the presence of phrenic ganglia, and possible connections to the celiac plexus. One hundred and thirty formalin-fixed adult cadavers were studied. The right phrenic nerve was found inferior to the diaphragm in 98% with 49.1% displaying a right phrenic ganglion. In 22.8% there was an additional smaller ganglion (right accessory phrenic ganglion). The remaining 50.9% had no grossly identifiable right phrenic ganglion. Most (65.5% of specimens) exhibited plexiform communications with the celiac ganglion, aorticorenal ganglion, and suprarenal gland. The left phrenic nerve inferior to the diaphragm was observed in 60% of specimens with 19% containing a left phrenic ganglion. No accessory left phrenic ganglia were observed. The left phrenic ganglion exhibited plexiform communications to several ganglia in 71.4% of specimens. Histologically, the right phrenic and left phrenic ganglia contained large soma concentrated in their peripheries. Both phrenic nerves and ganglia were closely related to the diaphragmatic crura. Surgically, sutures to approximate the crura for repair of hiatal hernias must be placed above the ganglia in order to avoid iatrogenic injuries to the autonomic supply to the diaphragm and abdomen. These findings could also provide a better understanding of the anatomy and distribution of the fibers of that autonomic supply.
authors.affiliation: Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies.
authors.forename: Marios
authors.initials: M
authors.lastname: Loukas
authors.affiliation: Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies.
authors.forename: Maira
authors.initials: M
authors.lastname: Du Plessis
authors.affiliation: Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Louis
authors.affiliation: Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies.|Section of Pediatric Neurosurgery, Children's Hospital, Alabama.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.affiliation: Department of Anatomical Sciences, School of Medicine, St George's University, Grenada, West Indies.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Wartmann
authors.affiliation: Department of Anatomy, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Nihal
authors.initials: N
authors.lastname: Apaydin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D003964:Diaphragm / Q000294:innervation*; D005260:Female; D005725:Ganglia, Autonomic / Q000033:anatomy & histology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000033:anatomy & histology*
keywords: celiac ganglion; diaphragm; phrenic ganglion; subdiaphragmatic phrenic nerve; suprarenal gland