Anat Cell Biol.  2019 Sep;52(3):221-225. 10.5115/acb.19.041.

Ansa cervicalis: a comprehensive review of its anatomy, variations, pathology, and surgical applications

• Kikuta S
• Jenkins S
• Kusukawa J
• Iwanaga J
• Loukas M
• Tubbs RS

• KMID: 2459535
• DOI: http://doi.org/10.5115/acb.19.041

Abstract

The ansa cervicalis is a neural loop in the neck formed by connecting the superior root from the cervical spinal nerves (C1-2) and the inferior root descending from C2-C3. It has various anatomical variations and can be an important acknowledgment in specific operations of the neck region. This is a review the anatomy, variations, pathology and clinical applications of the ansa cervicalis.

Keyword

Ansa cervicalis; Cervical spinal nerve; Hypoglossal nerve; Neck; Anatomy; Surgery

MeSH Terms

Hypoglossal Nerve
Neck
Pathology*
Spinal Nerves

Figure

• 

  Fig. 1 Schematic drawing of anatomical structures of the ansa cervicalis in the left neck. The platysma, sternocleidomastoid, omohyoid muscle, all veins and the submandibular gland were already dissected. AC, ansa cervicalis; CCA, common carotid artery; IR, inferior root; OM, omohyoid muscle; PN, phrenic nerve; SHM, sternohyoid muscle; SR, superior root; STM, sternothyroid muscle; X, vagus nerve; XII, hypoglossal nerve.

Reference

1. Clemente CD. Neuroanatomy and neurophysiology. In : Landau SI, editor. International Dictionary of Medicine and Biology. New York: John Wiley;1986. p. 1917–1925.

2. Tubbs RS, Salter EG, Oakes WJ. Anatomic landmarks for nerves of the neck: a vade mecum for neurosurgeons. Neurosurgery. 2005; 56:2 Suppl. 256–260.

3. Chaurasia B. Human anatomy: regional and applied head and neck and brain. New Delhi: CBS Publishers;1980.

4. Olry R, Haines DE. Ansa hypoglossi or ansa cervicalis? That is the question. J Hist Neurosci. 2002; 11:302–304.

5. Blythe JN, Matharu J, Reuther WJ, Brennan PA. Innervation of the lower third of the sternocleidomastoid muscle by the ansa cervicalis through the C1 descendens hypoglossal branch: a previously unreported anatomical variant. Br J Oral Maxillofac Surg. 2015; 53:470–471.

6. Chhetri DK, Berke GS. Ansa cervicalis nerve: review of the topographic anatomy and morphology. Laryngoscope. 1997; 107:1366–1372.

7. Standring S. Gray's anatomy: the anatomical basis of clinical practice. 41st ed. New York: Elsevier;2016.

8. Zapata P, Torrealba G. Reflex effects evoked by stimulation of hypoglossal afferent fibers. Brain Res. 1988; 445:19–29.

9. Turner W. A phrenic nerve receiving a root of origin from the descendens hypoglossi. J Anat Physiol. 1893; 27(Pt 3):427.

10. Lippmann R. Abnormer Ursprung des Ramus descendens N. Anat Anz. 1910; 37:1–4.

11. Schaefer E, Symington J, Bryce T. Quain's elements of anatomy. 11th ed. London: Longmans, Green, and Co.;1915.

12. Rodrigues A. Le descendens cervicalis chez l'homme et chez le mammifères (quelques notes sur son évolution phylogénique). Assoc Anat Comptes Rendus. 1930; 25:267–282.

13. Winckler G. A propros des relations que relations que existent entre le plexus cervical et le nerf grand hypoglosse. Assoc Anat Comptes Rendus. 1955; 42:1415–1419.

14. Wischnewsky A. Die Aufbautypen des Ramus descendens nervi hypoglossi. Z Anat Entwicklungsgeschichte. 1930; 92:551–564.

15. Khaki AA, Shokouhi G, Shoja MM, Farahani RM, Zarrintan S, Khaki A, Montazam H, Tanoomand A, Tubbs RS. Ansa cervicalis as a variant of spinal accessory nerve plexus: a case report. Clin Anat. 2006; 19:540–543.

16. Caliot P, Dumont D, Bousquet V, Midy D. A note on the anastomoses between the hypoglossal nerve and the cervical plexus. Surg Radiol Anat. 1986; 8:75–79.

17. Quadros LS, Prasanna LC, D'Souza AS, Singh A, Kalthur SG. Unilateral anatomical variation of the ansa cervicalis. Australas Med J. 2015; 8:170–173.

18. Kikuchi T. A contribution to the morphology of the ansa cervicalis and the phrenic nerve. Kaibogaku Zasshi. 1970; 45:242–281.

19. Banneheka S, Tokita K, Kumaki K. Nerve fiber analysis of ansa cervicalis-vagus communications. Anat Sci Int. 2008; 83:145–151.

20. Machalek L, Charamza J, Kikalova K, Bezdekova M. A variant case of ansa cervicalis. Int J Anat Var. 2009; 2:150–152.

21. Jelev L. Some unusual types of formation of the ansa cervicalis in humans and proposal of a new morphological classification. Clin Anat. 2013; 26:961–965.

22. Venigopal SP, Mallula SB. Ansa cervicalis: without loop. Int J Anat Var. 2010; 3:153–155.

23. Rao TR, Shetty P, Rao SR. A rare case of formation of double ansa cervicalis. Neuroanatomy. 2007; 6:26–27.

24. Kumar N, Patil J, Mohandas R, Sirasanagandla , Nayak S, Guru A. Rare case of double looped ansa cervicalis associated with its deep position in the carotid triangle of the neck. Ann Med Health Sci Res. 2014; 4:Suppl 1. S29–S31.

25. Sangvichien S, Putsom O, Chuncharunee A. Anatomical variations of the ansa cervicalis in Thais. Siriraj Med J. 2003; 55:91–99.

26. Manjunath KY. Vagal origin of the ANSA cervicalis nerve: report of two cases. Indian J Otolaryngol Head Neck Surg. 2000; 52:257–258.

27. Vollala VR, Bhat SM, Nayak S, Raghunathan D, Samuel VP, Rodrigues V, Mathew JG. A rare origin of upper root of ansa cervicalis from vagus nerve: a case report. Neuroanatomy. 2005; 4:8–9.

28. D'Souza AS, Ray B. Study of the formation and distribution of the ansa cervicalis and its clinical significance. Eur J Anat. 2010; 14:143–148.

29. Ayyoubian M, Koruji M. A rare anatomical variant of ansa cervicalis: case report. Med J Islam Repub Iran. 2011; 24:238–240.

30. Rath G, Anand C. Vagocervical complex replacing an absent ansa cervicalis. Surg Radiol Anat. 1994; 16:441–443.

31. Verma R, Das S, Suri R. Unusual organization of the ansa cervicalis : a case report. Braz J Morphol Sci. 2005; 22:175–177.

32. Nayak SB, Shetty P, Reghunathan D, Aithal AP, Kumar N. Descendens vagohypoglossi: rare variant of the superior root of ansa cervicalis. Br J Oral Maxillofac Surg. 2017; 55:834–835.

33. Abu-Hijleh MF. Bilateral absence of ansa cervicalis replaced by vagocervical plexus: case report and literature review. Ann Anat. 2005; 187:121–125.

34. Indrasingh I, Vettivel S. A rare pseudo ansa cervicalis: a case report. J Anat Soc India. 2000; 49:178–179.

35. Banneheka S. Anatomy of the ansa cervicalis: nerve fiber analysis. Anat Sci Int. 2008; 83:61–67.

36. Hirabayashi S, Sakurai A, Fukuda O. Neurilemoma of the ansa cervicalis. Plast Reconstr Surg. 1987; 79:809–811.

37. de Diego Sastre JI, Melcón Díez E, Prim Espada MP. Neurilemmoma of the ansa cervicalis: a case report. Acta Otorrinolaringol Esp. 1996; 47:83–84.

38. Okonkwo O, Doshi J, Minhas S. Schwannoma of the ansa cervicalis. J Surg Case Rep. 2011; 2011:3.

39. Park JH, Ahn D, Hwang KH, Jeong JY. Schwannoma of ansa cervicalis in the submandibular space. Korean J Otorhinolaryngol-Head Neck Surg. 2014; 57:616–619.

40. Rath S, Sasmal PK, Saha K, Deep N, Mishra P, Mishra TS, Sharma R. Ancient Schwannoma of ansa cervicalis: a rare clinical entity and review of the literature. Case Rep Surg. 2015; 2015:578467.

41. Righini CA, Motto E, Faure C, Karkas A, Lefournier V, Reyt E. Schwannomas of the neck About 3 cases, and literature review. Rev Laryngol Otol Rhinol (Bord). 2007; 128:109–115.

42. Kang GC, Soo KC, Lim DT. Extracranial non-vestibular head and neck schwannomas: a ten-year experience. Ann Acad Med Singapore. 2007; 36:233–238.

43. Kim SH, Kim NH, Kim KR, Lee JH, Choi HS. Schwannoma in head and neck: preoperative imaging study and intracapsular enucleation for functional nerve preservation. Yonsei Med J. 2010; 51:938–942.

44. Kamal A, Abd El-Fattah AM, Tawfik A, Abdel Razek AA. Cervical sympathetic schwannoma with postoperative first bite syndrome. Eur Arch Otorhinolaryngol. 2007; 264:1109–1111.

45. Zhang H, Cai C, Wang S, Liu H, Ye Y, Chen X. Extracranial head and neck schwannomas: a clinical analysis of 33 patients. Laryngoscope. 2007; 117:278–281.

46. Paniello RC. Laryngeal reinnervation. Otolaryngol Clin North Am. 2004; 37:161–181.

47. Baba M, Aikou T, Natsugoe S, Kusano C, Shimada M, Nakano S, Fukumoto T, Yoshinaka H. Quality of life following esophagectomy with three-field lymphadenectomy for carcinoma, focusing on its relationship to vocal cord palsy. Dis Esophagus. 1998; 11:28–34.

48. Loukas M, Thorsell A, Tubbs RS, Kapos T, Louis RG Jr, Vulis M, Hage R, Jordan R. The ansa cervicalis revisited. Folia Morphol (Warsz). 2007; 66:120–125.

49. Frazier CH. Anastomosis of the recurrent laryngeal nerve with the descendens noni: in cases of recurrent laryngeal paralysis. JAMA. 1924; 83:1637–1641.

50. Crumley RL. Unilateral recurrent laryngeal nerve paralysis. J Voice. 1994; 8:79–83.

51. Prades JM, Gavid M, Dubois MD, Dumollard JM, Timoshenko AT, Peoc'h M. Surgical anatomy of the ansa cervicalis nerve: which branch to use for laryngeal reinnervation in humans? Surg Radiol Anat. 2015; 37:139–145.

52. Chhetri DK, Blumin JH. Laryngeal reinnervation for unilateral vocal fold paralysis using ansa cervicalis nerve to recurrent laryngeal nerve anastomosis. Oper Tech Otolaryngol Head Neck Surg. 2012; 23:173–177.

53. Isshiki N, Okamura H, Ishikawa T. Thyroplasty type I (lateral compression) for dysphonia due to vocal cord paralysis or atrophy. Acta Otolaryngol. 1975; 80:465–473.

54. Isshiki N, Tanabe M, Sawada M. Arytenoid adduction for unilateral vocal cord paralysis. Arch Otolaryngol. 1978; 104:555–558.

55. Arnold GE. Vocal rehabilitation of paralytic dysphonia. VIII. Phoniatric methods of vocal compensation. Arch Otolaryngol. 1962; 76:76–83.

56. Tucker HM, Rusnov M. Laryngeal reinnervation for unilateral vocal cord paralysis: long-term results. Ann Otol Rhinol Laryngol. 1981; 90(5 Pt 1):457–459.

57. Yoleri L, Songür E, Yoleri O, Vural T, Cağdaş A. Reanimation of early facial paralysis with hypoglossal/facial end-to-side neurorrhaphy: a new approach. J Reconstr Microsurg. 2000; 16:347–355.

58. Deganello A, De Bree R, Dolivet G, Leemans CR. Infrahyoid myocutaneous flap reconstruction after wide local excision of a Merkel cell carcinoma. Acta Otorhinolaryngol Ital. 2005; 25:50–53.