Frank D K, Wenk E, Stern J C, Gottlieb R D, Moscatello A L
Department of Otolaryngology-Head and Neck Surgery, The New York Eye and Ear Infirmary and Affiliated Hospitals of the New York Medical College, New York City, USA.
Otolaryngol Head Neck Surg. 1997 Dec;117(6):671-80. doi: 10.1016/S0194-59989770051-2.
Understanding the surgical anatomic relationships of the motor nerves to the levator scapulae muscle is imperative for reducing postoperative shoulder dysfunction in patients undergoing neck dissection. To elucidate this relevant anatomy, cervical (C3, C4) and brachial (C5 via dorsal scapular nerve) plexi contributions to the levator scapulae were assessed with respect to posterior triangle landmarks in 37 human cadaveric necks. An average of approximately 2 (actual 1.92) nerves from the cervical plexus (range 1 to 4 nerves) emerged from beneath the posterior border of the sternocleidomastoid muscle in a cephalad to caudad progression to enter the posterior triangle of the neck on their way to innervating the levator scapulae. These cervical plexus contributions exhibited a fairly regular relationship to the emergence of cranial nerve XI and the punctum nervosum along the posterior border of the sternocleidomastoid muscle. After emerging from the posterior border of the sternocleidomastoid to enter the posterior triangle of the neck, cervical plexus contributions to the levator scapulae traveled for a variable distance posteriorly and inferiorly, sometimes branching or coming together. Ultimately these nerves crossed the anterior border of the levator scapulae as 1 to 3 nerves (average 1.94) in a regular superior to inferior progression. The dorsal scapular nerve from the brachial plexus exhibited highly variable anatomic relations in the inferior aspect of the posterior triangle, and was found to penetrate or give branches to the levator scapulae in only 11 of 35 neck specimens. We have found that the levator scapulae receives predictable motor supply from the cervical plexus. Our data elucidate surgical anatomy useful to head and neck surgeons.
了解运动神经与肩胛提肌的手术解剖关系对于减少接受颈部清扫术患者的术后肩部功能障碍至关重要。为了阐明这一相关解剖结构，在37具人类尸体颈部中，针对后三角标志评估了颈丛（C3、C4）和臂丛（通过肩胛背神经的C5）对肩胛提肌的贡献。平均约2条（实际为1.92条）来自颈丛的神经（范围为1至4条神经）从胸锁乳突肌后缘下方以头端至尾端的顺序穿出，在进入颈部后三角以支配肩胛提肌的途中穿出。这些颈丛分支与沿胸锁乳突肌后缘的副神经和神经点的出现呈现出相当规律的关系。从胸锁乳突肌后缘穿出进入颈部后三角后，颈丛对肩胛提肌的分支向后下方走行一段可变距离，有时分支或合并。最终，这些神经以1至3条神经（平均1.94条）的形式以规则的从上到下顺序穿过肩胛提肌的前缘。臂丛的肩胛背神经在后三角下部表现出高度可变的解剖关系，并且在35个颈部标本中仅在11个标本中发现其穿透或分支至肩胛提肌。我们发现肩胛提肌从颈丛接受可预测的运动供应。我们的数据阐明了对头颈外科医生有用的手术解剖结构。
