[Impaired motor functions. Surgical and conservative procedures for restoring motor functions of the facial nerve, accessory nerve, hypoglossal nerve].
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Accessory Nerve Diseases↗
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The 11th nerve syndrome. Accessory nerve palsy or adhesive capsulitis?
The 11th nerve syndrome classically involves the majority of patients undergoing neck dissections even when the accessory nerve is preserved. A preliminary analysis of our data of 31 of 44 patients who underwent neck dissections from a prospective study showed numerous findings of shoulder disability that are not attributable to accessory nerve palsy but are well described by the syndrome of adhesive capsulitis of the glenohumeral joint. At 1 month postoperatively, although accessory nerve palsy symptoms were common, adhesive capsulitis symptoms were significant. At 6 months, the frequency of accessory nerve palsy symptoms was less as the accessory nerve had begun to recover. At 12 and 18 months, when most of the accessory nerves had recovered, the accessory nerve palsy symptoms were comparatively uncommon while the adhesive capsulitis symptoms predominated as the remaining symptoms of the 11th nerve syndrome. We propose that adhesive capsulitis is a principal component of the 11th nerve syndrome that can significantly compound the morbidity of a neck dissection even when the accessory nerve recovers. We also propose that adhesive capsulitis accounts for the persistence and variability of shoulder symptoms after neck dissection that cannot be attributed to trapezius muscle dysfunction.
Accessory Nerve↗
Anatomical and functional connectivity of the transected ulnar nerve after accessory nerve neurotization in the cat.
AIM: The objective of this experimental study was to test the capacity of accessory nerve motoneurons to innervate muscles of the ulnar nerve territory after direct anastomosis. METHODS: This study used 22 cats in two groups: experimental group (15 cats) and control group (7 cats). The first one was followed during twelve months using electromyographic records every two months postsurgery; muscle and nerve histological assessment and counting horseradish peroxidase-labeled motoneurons. RESULTS: Our results showed that reinnervation was achieved in 12/15 nerves. The number of HRP labelled medullar motoneurons after anastomosis showed a significant statistic difference with a simple ulnar nerve transection; there was no significant statistic difference in labelling between the group with an anastomosis and the one with a simple accessory nerve transection. CONCLUSIONS: Direct anastomosis between the spinal accessory nerve and the ulnar nerve is achievable and thus, the accessory spinal nerve is another possible choice for correcting the motor deficit arising from lower brachial plexus avulsion, but the limited number of motoneurons would only allow partial reinnervation..
Accessory Nerve↗
Nerve injury about the shoulder in athletes, part 2: long thoracic nerve, spinal accessory nerve, burners/stingers, thoracic outlet syndrome.
Nerve injuries about the shoulder in athletes are being recognized with increasing frequency. Prompt and correct diagnosis of these injuries is important to treat the patient and to understand the potential complications and natural history, so as to counsel our athletes appropriately. This 2-part article is a review and an overview of the current state of knowledge regarding some of the more common nerve injuries seen about the shoulder in athletes, including long thoracic nerve, spinal accessory nerve, burners and stingers, and thoracic outlet syndrome. Each of these clinical entities will be discussed independently, reviewing the anatomy, mechanism of injury, patient presentation (history and examination), the role of additional diagnostic studies, differential diagnosis, and management.
Accessory Nerve Injuries↗
[Reconstruction for brachial injury by the accessory nerve--anatomy of the accessory nerve and its innervation of the trapezius--Japan].
At present reconstruction of not only elbow function, but also wrist and fingers function is possible for totally paralysed root avulsion type of brachial plexus injuries by means of multiple nerve transfers and free muscle transplantation. Although denervation of the trapezius muscle may be a problem, the accessory nerve is used as the donor nerve for reconstruction. Forty-seven cadaver dissections were performed to determine the innervation of the trapezius. In 98% of the regions, branches of the accessory nerve or the cervical nerves were found to be directly innervated with the accessory nerve in the posterior triangle of the neck without anastomosis. This study came to the conclusion that it was possible to use the accessory nerve as the donor nerve without paralysis of the upper part of the trapezius, if the accessory nerve was used at an adequate point. Since the course of the accessory nerve is similar to one of the cervical nerve in the posterior triangle of the neck, it is difficult to distinguish them. The layer of the course and the great auricular nerve at the posterior margin of the sternocleidomastoid are reference points of the accessory nerve and the cervical nerves.
Accessory Nerve↗
The anatomy of the inferior petrosal sinus, glossopharyngeal nerve, vagus nerve, and accessory nerve in the jugular foramen.
PURPOSE: To define the variations of the courses of the cranial nerves and the inferior petrosal sinuses as they enter and traverse the jugular foramen. METHODS: Thirty-nine cadaveric specimens containing the jugular foramen were scanned with 1-mm contiguous axial and coronal CT sections. Each specimen was dissected to evaluate the position of the cranial nerves and inferior petrosal sinus as they entered the jugular foramen. RESULTS: The glossopharyngeal nerve entered the most superior, anterior, and medial aspect of the jugular foramen and descended in the anterior portion of the jugular foramen, often within a groove. The vagus and accessory nerves could not be separated by CT. They entered the jugular foramen most often anterior or anterior and inferior to the jugular spine of the temporal bone and descended in a position ranging from medial to anterior to the jugular vein. The inferior petrosal sinus most often coursed inferior to the horizontal portion of the glossopharyngeal nerve and entered the jugular system in the jugular foramen, at the exocranial opening or below the skull base. A pars nervosa and pars venosa could be identified only at the endocranial opening, where the jugular spine separated the pars nervosa containing the inferior petrosal sinus and three cranial nerves from the pars venosa containing the jugular vein. CONCLUSION: Our evaluation demonstrated anatomic variation in the area of the jugular foramen.
Accessory Nerve↗
[Accessory femoral nerve, accessory obturator nerve, and their practical significance in hip joint surgery].
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Femoral Nerve↗
[Iatrogenic neuropathy of the XI cranial nerve or accessory nerve].
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Accessory Nerve↗
Ultrasonography of the accessory nerve: normal and pathologic findings in cadavers and patients with iatrogenic accessory nerve palsy.
OBJECTIVE: To determine feasibility of ultrasonography in detecting the normal accessory nerve as well as pathologic changes in cases of accessory nerve palsy. METHODS: Four patients with accessory nerve palsy were investigated by ultrasonography. Three cases of accessory nerve palsy after lymph node biopsy and neck dissection were primarily diagnosed on the basis of ultrasonography using a 5- to 12-MHz linear transducer. In addition, we performed ultrasonography in 3 cadaveric specimens to show the feasibility of detecting the accessory nerve. RESULT: Nerve transection (n = 2), scar tissue (n = 1), and atrophy of the trapezius muscle (n = 4) were confirmed by electroneurographic testing and surgical nerve inspection. In 1 case in which a patient had a whiplash injury with accessory nerve palsy, ultrasonography showed atrophy of the trapezius muscle with a normal nerve appearance. CONCLUSIONS: Ultrasonography allows visualization of the normal accessory nerve as well as changes after accessory nerve palsy.
Accessory Nerve↗
Iatrogenic accessory nerve injury.
Accessory nerve injury produces considerable disability. The nerve is most frequently damaged as a complication of radical neck dissection, cervical lymph node biopsy and other surgical procedures. The problem is frequently compounded by a failure to recognise the error immediately after surgery when surgical repair has the greatest chance of success. We present cases which outline the risk of accessory nerve injury, the spectrum of clinical presentations and the problems produced by a failure to recognise the deficit. Regional anatomy, consequences of nerve damage and management options are discussed. Diagnostic biopsy of neck nodes should not be undertaken as a primary investigation and, when indicated, surgery in this region should be performed by suitably trained staff under well-defined conditions. Awareness of iatrogenic injury and its consequences would avoid delays in diagnosis and treatment.
Accessory Nerve↗
Management of iatrogenic injury to the spinal accessory nerve.
Spinal accessory nerve injury results in a debilitating shoulder dysfunction. The trapezius is a major suspensory muscle of the shoulder girdle, and paralysis results in chronic pain and debility from disruption of synchronous scapulohumeral rhythm. This injury usually follows a simple posterior triangle lymph node biopsy and is treatable if appropriate measures are taken in a timely fashion. A major pitfall in early management is either failure to recognize or acknowledge the injury or hoping that it will resolve with conservative treatment. Variation of innervation of the trapezius alters clinical presentation and can make diagnosis difficult. We present a series of six patients with iatrogenic spinal accessory nerve injury following a neck node biopsy. Pain was the most common presenting symptom, and a loss of sustained abduction was the most common physical sign. Three patients had a primary nerve repair and the other three patients had nerve grafting. Maximum recovery time ranged from 4 to 10 months. All patients had varying degrees of recovery of motor function, and all six patients were 100 percent painfree. An algorithm for the management of this distressing condition emphasizes the importance of early referral and highlights the pitfalls in making an accurate diagnosis. Whereas conservative therapy is less predictable and needs careful selection, it also runs the risk of delaying a more effective surgical management. Early operative intervention is more definitive and has the best functional results. Prevention is key and is best achieved by avoiding unnecessary biopsies of the posterior triangle lymph node. When operating, knowledge of posterior neck anatomy and judicious use of the bipolar cautery and magnifying loupes are essential in preventing this problem.
Accessory Nerve↗
Isolated accessory nerve palsy.
Accessory nerve palsy is either idiopathic or secondary to local trauma, infection, or tumor. The discomfort and disability produced as a result of trapezius weakness may be significant. The clinical features and management of accessory nerve palsy have been discussed.
Accessory Nerve↗
Analysis of motor fibers in the communicating branch between the cervical nerves and the spinal accessory nerve to innervate trapezius in the rat.
The communicating branch between the ventral rami of cervical nerves and the spinal accessory nerve (SAN) has been reported to also send motor fibers to supply the trapezius. However, the motor fiber type of the communicating branch and its peripheral distribution are still unclear. To determine the fiber elements within the branch and its peripheral distribution of the motor fibers in the trapezius, the anterograde tracing method was used in this study. The results show that a few a motor end plates from the communicating branch were observed on the extrafusal fibers, while in the muscle spindle the motor elements from the communicating branch were distributed to the polar portions of the intrafusal fibers. These results indicated that the motor fibers passing through the communicating branch to supply the trapezius are mainly y motor fibers, with some a motor fibers. Moreover, the a and y motor fibers from the communicating branch were observed in the clavotrapezius, acromiotrapezius and the rostral part of spinotrapezius. These findings also correlate with the clinical observation indicating that even when the spinal accessory nerve is injured, the trapezius is still capable of slight movement.
Accessory Nerve↗
A technic for anastomosis of the facial nerve and spinal accessory nerve.
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Accessory Nerve↗
Traumatic spinal accessory nerve palsy.
Spinal accessory nerve sections due to a purely traumatic origin are very rare. The authors report a case in which a total section of the spinal accessory nerve was observed after a glass-penetrating injury. The primary lesion was undiagnosed, and only late physical examination revealed a scapula alata with a deficiency in shoulder protrusion and elevation. Surgical exploration with direct suturing of the nerve was performed 2 months after the initial trauma; full restoration of muscle function was obtained 12 months after the surgical procedure. Pain, the dominant preoperative feature, totally disappeared after restoration of shoulder function. Although infrequent, spinal accessory nerve lesions must always be excluded in cases of penetrating injuries in the posterior triangle of the neck. Emphasis is placed on diagnosis and treatment of this condition.
Accessory Nerve↗
Ultrastructural changes in the nerve fiber population of anastomosed vagal and spinal accessory nerves in the sheep.
BACKGROUND: The ultrastructure of the vagal and spinal accessory nerves was studied 1) in normal sheep and 2) in sheep in which an experimental crossed-nerve anastomosis had been made by sectioning the supranodose vagal and spinal accessory nerves, then suturing the distal end of the vagal nerve to the distal end of the spinal accessory nerve, and allowing time for regeneration to occur. This study was carried out in order to analyze the modifications liable to occur when this technique is used and to specify the origin and the nature of the fibers that colonize the spinal accessory nerve. METHODS: The study was performed in 4- to 5-month-old-sheep. After the surgical procedure, the animals were housed indoors during 1 year until their sacrifice by fixative perfusion. Then, nerve samples were dissected out, processed for electron microscopy, examined, and systematically photographed. After printing, the diameters of the nerve fibers were determined. RESULTS: In sheep, the ratios of nonmyelinated to myelinated fibers (NF/MF) in the infranodose and supranodose vagal nerve and accessory spinal nerve were 1.21, 1.67, and 3.21, respectively. In both parts of the vagal nerve, the myelinated fibers had a unimodal diameter distribution around a peak of 4 microns; whereas, in the spinal accessory nerve, they were distributed bimodally, and 53% had values of 15-18 microns. After making the above anastomosis, the centrifugal vagal fibers degenerated, and the NF/MF ratios increased in the centripetal infranodose vagal nerve, in the reinnervating supranodose vagal nerve, and in the reinnervated spinal accessory nerve (approximately 1.87, 1.72, and 6.04, respectively). In all of these nerves, the myelinated fibers had a unimodal distribution with a peak at 4 microns, as in the vagal nerve of normal sheep. CONCLUSIONS: These results reveal the large part taken by the nonmyelinated fibers in the nerve fiber population of the vagal nerve and support the vagal origin of the fibers reinnervating the spinal accessory nerve.
Accessory Nerve↗
Refinements in the technique for repair of the accessory nerve.
Trapezius muscle palsy after accessory nerve injury leads to periscapular pain and shoulder motion deficit. The results of accessory nerve repair generally are good, but surgery is difficult. The difficulty consists of finding the nerve stumps that are embedded in fat and scar tissue from previous surgeries or injuries. Five patients with accessory nerve lesions had surgery and grafting of the accessory nerve. We dissected the proximal stump of the accessory nerve within the fibers of the sternocleidomastoid muscle and in the vicinity of the greater auricular nerve. To achieve dissection of the distal nerve stump, the deep cervical fascia was detached from the trapezius muscle 3 cm cephalad to the clavicle. The detached fascia and the trapezius muscle were flipped similar to book pages. The motor branches entering the trapezius muscle were visualized and followed toward the accessory nerve. A sural nerve graft with a mean length of 6.6 cm was used for grafting. Uncomplicated identification of the nerve stumps was possible in all patients. After accessory nerve grafting, pain and motion consistently improved in all patients. The technique proposed here ensures reliable and rapid identification of the divided stumps of the accessory nerve.
Accessory Nerve↗
[Isolated lesion of the accessory nerve].
An isolated accessory nerve lesion was diagnosed in three patients. At clinical investigation of patients with this lesion, paresis of the trapezius muscle is found. This finding can be substantiated by electromyography. An accessory nerve lesion is usually caused by trauma (including surgical trauma) or space-occupying lesions such as tumour or abscess. There are also idiopathic forms. The prognosis is poor. Treatment may include electrostimulation, administration of NSAIDs, nerve transplantation and muscle transposition.
Accessory Nerve↗