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Ultrasonography of the Accessory Nerve

Normal and Pathologic Findings in Cadavers and Patients With Iatrogenic Accessory Nerve Palsy

Departments of Radiology (G.B., P.K., H.G., S.P., A.M.) and Plastic Surgery (C.H., A.G.) and Institute of Anatomy (A.G., P.K., H.G.), University of Innsbruck, University Hospital Innsbruck, Innsbruck, Austria.

Address correspondence and reprint requests to Gerd Bodner, MD, University Hospital of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.

Objective. To determine feasibility of ultrasonography in detecting the normal accessory nerve as well as pathologic changes in cases of accessory nerve palsy. Methods. Four patients with accessory nerve palsy were investigated by ultrasonography. Three cases of accessory nerve palsy after lymph node biopsy and neck dissection were primarily diagnosed on the basis of ultrasonography using a 5- to 12-MHz linear transducer. In addition, we performed ultrasonography in 3 cadaveric specimens to show the feasibility of detecting the accessory nerve. Results. Nerve transection (n = 2), scar tissue (n = 1), and atrophy of the trapezius muscle (n = 4) were confirmed by electroneurographic testing and surgical nerve inspection. In 1 case in which a patient had a whiplash injury with accessory nerve palsy, ultrasonography showed atrophy of the trapezius muscle with a normal nerve appearance. Conclusions. Ultrasonography allows visualization of the normal accessory nerve as well as changes after accessory nerve palsy.

Abbreviations: HRUS, high-resolution ultrasonography

Key Words: accessory nerve • lymph node biopsy • muscular atrophy • ultrasonography

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