PubMed · 1622328
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R J Muirhead, V L Hale. 1992. Cervical flexor strength.. https://pubmed.ncbi.nlm.nih.gov/1622328/
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The radical neck dissection is an operation for the management of lymph node metastases from primary sites involving the oral cavity, larynx, and other areas of the head and neck. In this procedure, the spinal accessory nerve is removed along with other structures. In modified neck dissection the spinal accessory nerve is preserved. Patients undergoing the modified neck dissection have had variable functional outcomes from little or no pain or disability, to significant muscle dysfunction. Our group hypothesized that patients with good functional outcomes following modified neck dissection may have had motor contributions from C2, C3, or C4 branches, while those with less favorable outcomes did not. To demonstrate the presence of motor input and its significance both from the spinal accessory nerve and the branches of the cervical plexus, we utilized intraoperative electroneurography. We find that although there is motor contribution from C2, C3, and C4 to the trapezius muscle, it was not consistent or significant.
In recent years, there has been a proliferation of techniques utilizing the ansa cervicalis nerve to reinnervate the paralyzed larynx. The anatomic course and morphology of the ansa cervicalis are complicated by the variable course and location along the great vessels of the neck, as well as the significant differences observed in the arrangement of its contributing roots and regional branching patterns. Herein, we review the surgical anatomic course of ansa cervicalis and its innervation of the muscles of the neck, and develop specific recommendations with respect to the use of this nerve in laryngeal reinnervation.
Historically, carotid surgery is identified in the operating room as a major surgical procedure. Although the surgical intervention remains the same, a regional anesthetic technique calls upon perioperative nurses to utilize their assessment and planning skills astutely preparing innovative nursing interventions that enable successful patient outcomes. The key to a successful nursing care plan for a carotid endarterectomy performed under cervical plexus block is an awareness of the patient's physiological needs as well as the environmental influences they may be experiencing. As the administration of regional anesthesia for major surgery become more prevalent, there is a resurgent demand for traditional holistic nursing interventions in the operating room. The perioperative nurse must couple technical expertise with intuitive assessment skills and administration of compassionate nursing care.