head & neck surgery course - orl nimes · 2015. 3. 5. · head & neck surgery course dr...
TRANSCRIPT
![Page 1: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/1.jpg)
Head & Neck Surgery Course
Dr Pierfrancesco PELLICCIA
Pr Benjamin LALLEMANT
Service ORL et CMF
CHU de Nîmes
CH de Arles
Surgical anatomy of the neck: nerves
![Page 2: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/2.jpg)
Nerves in the neck
(summary)
![Page 3: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/3.jpg)
![Page 4: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/4.jpg)
![Page 5: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/5.jpg)
![Page 6: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/6.jpg)
![Page 7: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/7.jpg)
Vagus Nerve, Cranial Nerve X
![Page 8: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/8.jpg)
Origin from brain and exit from cranial cavity of CN X
![Page 9: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/9.jpg)
Physiology Skeletal muscle innervation of CN X
![Page 10: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/10.jpg)
Physiology
Parasympathetic innervation
![Page 11: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/11.jpg)
Accessory Nerve, Cranial Nerve XI
![Page 12: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/12.jpg)
Origin from brain and exit from cranial cavity of CN XI
![Page 13: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/13.jpg)
Physiology Skeletal muscle innervation of CN XI
![Page 14: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/14.jpg)
• Exit the skull base through jugular foramen
• Like IJV you can find it anterior to the atlas transverse process
• Penetrates deep surface of the SCM (between superior and middle third)
• Exits posterior surface of SCM 1 cm above to Erb’s point
• Traverses the posterior triangle on the levator scapulae
• Enters the trapezius about 5 cm above the clavicle (2 cm above the point where
the inferior belly of homoioyd muscle meet the trapezius)
CN XI: surgical considerations
![Page 15: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/15.jpg)
CN XI: relationship with the IJV
![Page 16: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/16.jpg)
CN XI in level II
![Page 17: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/17.jpg)
CN XI in level V
![Page 18: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/18.jpg)
Hypoglossal Nerve, Cranial Nerve XII
![Page 19: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/19.jpg)
Origin from brain and exit from cranial cavity of CN XII
![Page 20: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/20.jpg)
Physiology Skeletal muscle innervation of CN XII
![Page 21: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/21.jpg)
• Lies deep to the IJV, ICA, CN
IX, X, and XI
• Curves 90 degrees and passes
between the IJV and ICA
• Lateral to hyoglossus (with
ranine veins)
• Deep to mylohyoid
CN XII: surgical considerations
![Page 22: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/22.jpg)
Marginal Mandibular Nerve
![Page 23: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/23.jpg)
• Most commonly injury dissection level Ib
• Landmark:
– 1cm anterior and inferior to angle of
mandible
• Subplatysmal
• Deep to fascia of the submandibular gland
• Superficial to facial vein
• More than one branch often present
Marginal mandibular nerve: surgical considerations
![Page 24: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/24.jpg)
Marginal mandibular nerve: how to preserve it
![Page 25: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/25.jpg)
Cervical plexus
![Page 26: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/26.jpg)
Cervical plexus: anatomy (schematic)
![Page 27: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/27.jpg)
Cervical plexus: anatomy (schematic)
![Page 28: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/28.jpg)
Cervical plexus: anatomy (schematic)
![Page 29: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/29.jpg)
Cervical plexus in levels II and III
![Page 30: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/30.jpg)
Cervical plexus in levels II and III
![Page 31: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/31.jpg)
Cervical plexus: intraoperative view (bilateral neck dissection)
![Page 32: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/32.jpg)
Phrenic Nerve
• Sole nerve supply to the diaphragm
• C3-5
• Anterior surface of anterior scalene
• Under prevertebral fascia
• Posterolateral to carotid sheath
![Page 33: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/33.jpg)
Phrenic Nerve
• Sole nerve supply to the diaphragm
• C3-5
• Anterior surface of anterior scalene
• Under prevertebral fascia
• Posterolateral to carotid sheath
![Page 34: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/34.jpg)
Phrenic Nerve
![Page 35: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/35.jpg)
Brachial plexus
![Page 36: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/36.jpg)
Brachial plexus: anatomy (schematic)
![Page 37: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/37.jpg)
Brachial plexus: anatomy (schematic)
![Page 38: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/38.jpg)
Brachial plexus in level IV
![Page 39: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/39.jpg)
Brachial plexus in level IV
![Page 40: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/40.jpg)
Brachial plexus in level IV
![Page 41: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/41.jpg)
Head and Neck Sympathetic Innervation
![Page 42: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/42.jpg)
![Page 43: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/43.jpg)
Sympathetic trunk
![Page 44: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/44.jpg)
Sympathetic trunk
![Page 45: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/45.jpg)
Superior cervical ganglion
![Page 46: Head & Neck Surgery Course - ORL NIMES · 2015. 3. 5. · Head & Neck Surgery Course Dr Pierfrancesco PELLICCIA Pr Benjamin ... CHU de Nîmes CH de Arles Surgical anatomy of the neck:](https://reader035.vdocuments.us/reader035/viewer/2022062605/5fcc3e9c51b7815745210e22/html5/thumbnails/46.jpg)
Middle and inferior cervical ganglion