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Year |
2001 |
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Question Number |
272) |
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Category |
Select |
Question
Following a left sided approach for surgery on the anterior cervical spine, the patient reports a drooping left upper eyelid and dryness on the left side of her face. Which of the following structures has most likely been injured?
1) recurrent laryngeal nerve
2) superior laryngeal nerve
3) hypoglossal nerve
4) phrenic nerve
5) sympathetic chain
Figures
Answer (click for answer)
Preferred answer # 5
The sympathetic chain has been injured during the surgery on the anterior aspect of the spine. The patient has signs of a Horner’s syndrome ( anhydrosis of the face, ptosis and not listed in the question miosis). The sympathetic nerves are responsible for papillary dilatation, facial sweating and for assisting in maintaining the eye opened. The other nerves listed in the question could not account for the patients physical exam. The phrenic nerve innervates the diaphragm. The recurrent laryngeal nerve lies in the groove between the trachea and the esophagus. It gives branches to the pharynx, esophagus, and trachea. Injury to the recurrent laryngeal nerve results clinically in hoarseness. The superior laryngeal nerve is a branch of CN X, which divides, in the carotid sheath. The external laryngeal branch of the superior laryngeal nerve innervates the cricothyroid muscle. Injury to the superior laryngeal nerve would also cause damage to the larynx affecting the pitch of the voice.
Reference: Bridwell, K.H., DeWald, R.L.: The Textbook of Spine Surgery, ed 2. Philadelphia, PA, Lippincott-Raven, 1997, pp1427-1438.
Flynn, T.B: Neurologic complications of anterior cervical interbody fusion. Spine 1982;7:536-539