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Original Article

Anatomy and Blood Supply of the Lower Four Cranial and Cervical Nerves: Relevance to Surgical Neck Dissection

Henry Brown^*,1, Genvieve Hidden, Michelle Ledroux and Luciano Poitevan

^* The Harvard School of Medicine, The Departments of Anatomy and Plastic Surgery and The Brigham and Women's Hospital, Boston, Massachusetts 02115;
l'Institut d'Anatomie, UER Biomedicale Academie de Paris, Université Rene Déscartes, 75270 Paris Cedex 06, France; and
Department of Anatomy, The University of Buenos Aires, Buenos Aires, Argentina

This study is a continuation of previous work searching for possible anatomic reasons to explain variable and usually unpredictable postoperative pain and dysfunction after the same nerve losses with similar neck dissection operations. The study consisted of dissections of 19 deceased unpreserved elderly subjects arterially injected with dyed latex. Of the 19 subjects, 14 had brain stem and cervical spinal cord dissections, and all had neck dissections. The findings suggested two possible anatomic reasons for the pain and dysfunction: (i) The intracranial anatomy of the lower four cranial nerves, the glossopharyngeal (IX), the vagus (X), the spinal accessory (XI), and the hypoglossal (XII), was just as variable as the previously reported peripheral spinal accessory nerve plexus; and (ii) Both the intracranial and neck dissections indicated that the blood supply to the lower four cranial and cervical nerves, particularly to the brachial plexus, could be impaired by atherosclerosis and/or neuroforaminal impingement or operative loss. This loss of blood supply theoretically could result in ischemia as another possible cause of postoperative pain and dysfunction. It is concluded that because of the potential importance of each nerve and vessel, often unknown at operation, it is very important to spare as many of them as possible to avoid subsequent painful impairment.

This article has been cited by other articles:

				H. Brown Anatomy of the Spinal Accessory Nerve Plexus: Relevance to Head and Neck Cancer and Atherosclerosis Experimental Biology and Medicine, September 1, 2002; 227(8): 570 - 578. [Abstract] [Full Text] [PDF]