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The cranial nerves are an important part of the complex network of nerves in the human body. These nerves emerge directly from the brain and are responsible for transmitting essential information between the brain and various parts of the head and neck. There are 12 pairs of cranial nerves, systematically numbered using Roman numerals from I to XII, beginning from the anterior and moving to the posterior of the brain. Each cranial nerve is uniquely identified by names that reflect its function...
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Lower Cranial Nerves in the Neck: An Anatomical Study.

João V Pinto1,2,3, José Loureiro4, Ricardo Vaz1,4,3

  • 1Otorhinolaryngology Department, Unidade Local de Saúde de São João, Porto, PRT.

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|January 3, 2025
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Summary

This anatomical study reveals significant variability in the positions of lower cranial nerves (X, XI, XII) and neck landmarks. Understanding this variability, which can differ by gender, is crucial for preventing nerve injury during neck surgery.

Keywords:
accessory nervehypoglossal nervelower cranial nervesneck surgeryvagus nerve

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Area of Science:

  • Anatomy
  • Surgical Anatomy
  • Neuroanatomy

Background:

  • The lower cranial nerves (vagus nerve X, accessory nerve XI, hypoglossal nerve XII) are critical for head and neck function.
  • Variations in their anatomical course and relationship to surrounding structures can complicate surgical procedures.
  • Detailed topographical data is essential for surgical planning and minimizing iatrogenic injury.

Purpose of the Study:

  • To precisely analyze the distances and anatomical relationships between the lower cranial nerves (X, XI, and XII) and key neck landmarks.
  • To investigate potential gender-related differences in these anatomical variations.
  • To provide updated anatomical data relevant to surgical interventions in the neck.

Main Methods:

  • Neck dissections were performed on Thiel-embalmed cadavers (n=11, 18 dissections).
  • Measurements and observations focused on the vagus, accessory, and hypoglossal nerves relative to structures like the common carotid artery, internal jugular vein, and digastric muscle.
  • The emergence of the great auricular nerve and aspects of the ansa cervicalis were also examined.

Main Results:

  • The vagus nerve (X) exhibited a posterolateral course relative to the common carotid artery and medial to the internal jugular vein in over half the cases.
  • The accessory nerve (XI) showed varied positioning relative to the internal jugular vein depending on the level of dissection.
  • Significant gender-based differences were observed in the distances between the hypoglossal nerve (XII) and the carotid bifurcation, and the occipital artery's crossing point with the XII nerve.

Conclusions:

  • Considerable variability exists in the anatomical position, course, and distances of lower cranial nerves relative to standard neck landmarks.
  • The topography of these nerves can be influenced by gender, highlighting the need for individualized anatomical assessment.
  • Thorough anatomical knowledge is paramount for surgeons to avoid inadvertent injury to lower cranial nerves during neck procedures.