The Accessory Nerve: A Comprehensive Review of its Anatomy,Development, Variations,Landmarks and Clinical Considerations

Introduction: The eleventh cranial nerve, the accessory nerve, has a complex and unique anatomy and has been the subject of much debate. Herein, we review the morphology, embryology, surgical anatomy, and clinical manifestations of the accessory nerve. Included in this review, we mention variant anatomy, molecular development, histology, and imaging of the accessory nerve. Conclusions: The accessory nerve continues to be a topic of much discussion regarding its exact function and in particular to its cranial roots. Recently, various surgical procedures have been devised that repurpose the accessory nerve (e.g., lengthening procedures, contralateral neurotization procedures). Currently, we continue to learn and have much to learn about this lower cranial nerve. Anat Rec, 302:620–629, 2019. © 2018 Wiley Periodicals, Inc.     

Sound-evoked myogenic potentials on the sternocleidomastoid muscle in monkeys

Conclusion. We recorded sound-evoked myogenic potentials of the sternocleidomastoid (SCM) muscle using awake monkeys. The characteristics of these potentials are similar to those of vestibular evoked myogenic potentials (VEMPs) in humans, suggesting that the sound-evoked myogenic potentials of the SCM muscle in monkeys may be utilized as an animal model of VEMPs. Objective: The pathway of the VEMPs remains uncertain as no animal model has yet been used to record sound-evoked myogenic potentials in the SCM muscle. Therefore, the present study aimed to establish an animal model of VEMPs using macaque monkeys. Materials and methods. Four macaque monkeys were used. A pair of electrodes was attached on the SCM muscle ipsilateral side to the intense sound stimulation. Results. The sound-evoked myogenic potentials of the SCM muscle exhibited a biphasic waveform. When a click at 125 dBSPL was applied, the peak latency of the first positive wave was 12.5 ms and was not delayed when the stimulating sound intensity was reduced. The thresholds of the myogenic potentials were 103 dBSPL, which were 43 dB higher than those of the auditory brainstem response (ABR). When a short tone burst was applied, the reactive optimal frequency of the myogenic potentials was relatively low (500–1000 Hz).     

腮腺肿瘤不同切口及路径的手术效果比较

目的比较传统“S”形切口皮瓣转移修复术与改良“S”形切口腮腺筋膜缝合术治疗腮腺肿瘤的临床效果。方法将我科2011年3月—2012年3月期间收治的74例腮腺肿瘤患者按随机数字表法分为观察组42例和对照组32例。对照组患者采用“S”形切口及皮瓣转移修复术,观察组患者采用改良“S”形切口及腮腺筋膜缝合术治疗,术后随访1年,记录并比较两组患者并发症发生率及患者对术后切口外观的满意度情况。结果（1）观察组患者并发症发生率为31．0％,明显低于对照组的56．3％,两组比较差异有统计学意义（P〈0．05）;其中观察组患者的暂时性面瘫、耳颞神经综合征（Frey’s综合征）的发生率显著低于对照组（P〈0．05）。（2）两组患者对手术切口外观的满意度构成比无统计学差异（P〉0．05）,但观察组术后整体满意度达到10分的患者比例（38．1％）明显高于对照组（15．6％）,差异有统计学意义（P〈0．05）。结论改良“S”形切口及腮腺筋膜缝合术治疗腮腺肿瘤较之“S”形切口皮瓣转移修复术并发症发生率低,患者满意度高。     

胸锁乳突肌瓣在腮腺肿瘤切除术中的应用

目的:探讨腮腺手术中同期行胸锁乳突肌瓣转移术修复面部凹陷畸形的效果,及其对味觉出汗综合征(Frey综合征)预防作用。方法:对29例腮腺肿瘤病人行肿瘤加腮腺深叶或全叶切除术,其中18例同期行蒂在上的胸锁乳突肌瓣转移修复术为研究组;剩余11例,只行腮腺肿瘤切除术为对照组。术后随访观察治疗结果。结果:两组术后切口均I期愈合。经过12¹8个月随访,研究组侧面外形良好,颈部外形及功能正常,未出现Frey综合征。对照组,面部外形较差,5例出现Frey综合征。结论:胸锁乳突肌瓣转移术能明显改善腮腺肿瘤术后面侧部畸形,同时能有效降低味觉出汗综合征发生率。     

Morphological study of the attachment of the sternocleidomastoid muscle

INTRODUCTION

The sternocleidomastoid (SCM) muscle is a major muscle of the neck. Classically, this muscle is attached below the sternum and clavicle, although the mode of attachment might vary. As the SCM is related to numerous important neurovascular structures, its variable anatomy is clinically relevant, particularly for neck surgeries. A cadaveric study was performed to establish the variations present in the mode of attachment of the SCM muscle in an Indian population.

METHODS

We studied the variations in the attachment of the SCM muscle during the dissection of 18 cadavers for undergraduate teaching in two medical colleges in West Bengal, India.

RESULTS

Variations in the attachment of the SCM muscle were found in 5 (27.8%) specimens. Of these five specimens, three had unilateral variations and two had bilateral variations. In each specimen, the modes of presentation of the SCM and its fusion with the major bulk were also different.

CONCLUSION

In this study, we found variations in the attachment of the SCM muscle in more than a quarter of the specimens dissected. Surgeons should bear in mind such variations when performing neck surgeries.     

维持性血液透析患者甲状旁腺切除术后影响移植组织存活的危险因素

目的 探讨维持性血液透析（MHD）合并继发性甲状旁腺功能亢进（SHPT）患者接受甲状旁腺切除联合甲状旁腺部分组织移植在自体胸锁乳突肌区（TPTX+AT）后甲状旁腺移植的部位、方式以及甲状旁腺组织存活影响因素。方法 回顾性分析2010年1月~2020年2月在广东药科大学附属第一医院因SHPT接受TPTX+AT的MHD患者的临床资料。收集入选患者的一般临床资料和围手术期iPTH、血磷、血钙、ALP,血红蛋白（Hb）指标结果。根据术后2周双前臂及甲状旁腺素（iPTH）比值>1.5与否分为成活组与未成活组。比较两组患者的一般临床资料和围手术期相关指标的差异,logistics回归分析影响患者术后甲状旁腺移植存活的危险因素。结果 87例患者纳入本研究,术后甲状旁腺移植的存活率为78.16%。甲状旁腺移植存活组与非存活组术后1周、1月、2月、3月、6月、12月的血钙、血磷、iPTH、碱性磷酸酶（ALP）较术前明显下降(P<0.001);血红蛋白较术前明显升高（P=0.007）。多元线性回归分析ALP是影响甲状旁腺移植存活的独立危险因素[OR=1.003,95%CI（1.001,1.005）,P=0.004]。结论 TPTX+AT是治疗SHPT的一种安全有效的方法,术前血ALP较高的患者术后甲状旁腺组织不容易存活。     

三叉神经-颈反射检测方法的建立和正常值及在神经损伤时的评估作用

目的建立三叉神经-颈反射的肌电检测方法,测量国人正常值,探讨其临床应用。方法70例志愿者,取仰卧位,轻度收缩胸锁乳突肌,于眶下孔附近刺激,胸锁乳突肌记录。结果刺激正常受试者一侧的眶下神经,可引起双侧的正/负波。结论三叉神经-颈反射能够可靠测定,在下位脑干损伤的定位诊断中有一定作用。