title: Sternocleidomastoid innervation from an aberrant nerve arising from the hypoglossal nerve: a prospective study of 160 neck dissections.
abstract: BACKGROUND
  Anatomical variants of the spinal root of the accessory nerve and cervical plexus are well known but other variants are exceptionally rare.
  
  
  METHODS
  A prospective study of 160 selective neck dissections was undertaken following an index case, where a presumed C1 nerve (travelling with the hypoglossal nerve) was found to innervate sternocleidomastoid (SCM). A search was subsequently made for this variant while not compromising the neck dissection surgery itself. Eight cases could not be included due to metastatic disease precluding safe dissection in this area. A nerve stimulator was used to confirm the motor supply to SCM.
  
  
  RESULTS
  This nerve variant was found in 4/160 necks (2.5 %). In all cases, it originated directly from the hypoglossal nerve and stimulation resulted in isolated SCM contraction. No accessory nerve anomalies were found.
  
  
  CONCLUSIONS
  This finding adds to the knowledge of variants in this area. Meticulous dissection and preservation of all nerves, where possible, is important for optimising functional outcomes following surgery.
authors.affiliation: Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK. Peter.brennan@porthosp.nhs.uk.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Brennan
authors.affiliation: Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
authors.forename: Peyman
authors.initials: P
authors.lastname: Alam
authors.affiliation: Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Ammar
authors.affiliation: Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
authors.forename: Constantine
authors.initials: C
authors.lastname: Tsiroyannis
authors.affiliation: Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
authors.forename: Eirini
authors.initials: E
authors.lastname: Zagkou
authors.affiliation: Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.|Department of Anatomy, King's College London, London, SE1 1UL, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Standring
mesh_terms: D000055:Accessory Nerve / Q000033:anatomy & histology*; D063405:Anatomic Variation; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002572:Cervical Plexus / Q000033:anatomy & histology*; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D007002:Hypoglossal Nerve / Q000002:abnormalities*; D037981:Neck Dissection; D009334:Neck Muscles / Q000294:innervation*; D011446:Prospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D034941:Upper Extremity
keywords: Ansa cervicalis; Hypoglossal nerve; Nerve variant; Sternocleidomastoid muscle