Vol 66, No 2 (2007)
Original article
Submitted: 2012-02-06
Published online: 2007-03-09
The ansa cervicalis revisited
M. Loukas, A. Thorsell, R.S. Tubbs, T. Kapos, R.G. Louis Jr., M. Vulis, R. Hage, R. Jordan
Folia Morphol 2007;66(2):120-125.
Vol 66, No 2 (2007)
ORIGINAL ARTICLES
Submitted: 2012-02-06
Published online: 2007-03-09
Abstract
Recurrent laryngeal nerve paralysis represents a major complication in oesophageal cancer surgery. Nerve-muscle transplantation to the paraglottic space after resection of the recurrent laryngeal nerve with the ansa cervicalis (AC) has recently become the procedure of choice. The aim of this study was to investigate the anatomical variations of AC in order to avoid iatrogenic injuries and facilitate surgical procedures. We examined 100 adult human formalin-fixed cadavers. The ansa cervicalis showed a great degree of variation regarding origin and distribution. The origin of the superior root of AC was found to be superior to the digastric muscle in 92% of the cases. Its vertical descent was found to be superficial to the external carotid artery in 72% and superficial to the internal carotid artery in 28% of the specimens. The inferior root of AC was derived from the primary rami of C2 and C3 in 38%, from C2, C3 and C4 in 10%, from C3 in 40% and from C2 in 12% of the cases. The inferior root passed posterolaterally to the internal jugular
vein in 74% and anteromedially in 26% of the cases. The roots of AC were long
(70%) or short (30%), and the union between the two roots was situated inferior or superior to the omohyoid. Not only is knowledge of the anatomy of the ansa cervicalis important for nerve grafting procedures, but surgeons should be aware of AC and its relationships to the great vessels of the neck in order to avoid inadvertent injury during surgical procedures of the neck.
Abstract
Recurrent laryngeal nerve paralysis represents a major complication in oesophageal cancer surgery. Nerve-muscle transplantation to the paraglottic space after resection of the recurrent laryngeal nerve with the ansa cervicalis (AC) has recently become the procedure of choice. The aim of this study was to investigate the anatomical variations of AC in order to avoid iatrogenic injuries and facilitate surgical procedures. We examined 100 adult human formalin-fixed cadavers. The ansa cervicalis showed a great degree of variation regarding origin and distribution. The origin of the superior root of AC was found to be superior to the digastric muscle in 92% of the cases. Its vertical descent was found to be superficial to the external carotid artery in 72% and superficial to the internal carotid artery in 28% of the specimens. The inferior root of AC was derived from the primary rami of C2 and C3 in 38%, from C2, C3 and C4 in 10%, from C3 in 40% and from C2 in 12% of the cases. The inferior root passed posterolaterally to the internal jugular
vein in 74% and anteromedially in 26% of the cases. The roots of AC were long
(70%) or short (30%), and the union between the two roots was situated inferior or superior to the omohyoid. Not only is knowledge of the anatomy of the ansa cervicalis important for nerve grafting procedures, but surgeons should be aware of AC and its relationships to the great vessels of the neck in order to avoid inadvertent injury during surgical procedures of the neck.
Keywords
ansa cervicalis; omohyoid; recurrent laryngeal nerve paralysis; laryngeal reinnervations
Title
The ansa cervicalis revisited
Journal
Folia Morphologica
Issue
Vol 66, No 2 (2007)
Article type
Original article
Pages
120-125
Published online
2007-03-09
Page views
1706
Article views/downloads
2565
Bibliographic record
Folia Morphol 2007;66(2):120-125.
Keywords
ansa cervicalis
omohyoid
recurrent laryngeal nerve paralysis
laryngeal reinnervations
Authors
M. Loukas
A. Thorsell
R.S. Tubbs
T. Kapos
R.G. Louis Jr.
M. Vulis
R. Hage
R. Jordan