The upper surface of the lateral part presents an oval eminence, the jugular tubercle, which overlies the hypoglossal canal and is sometimes crossed by an oblique groove for the glossopharyngeal, vagus, and accessory nerves.
32.
In the upper part, the carotid sheath also contains the glossopharyngeal nerve ( IX ), the accessory nerve ( XI ), and the hypoglossal nerve ( XII ), which pierce the fascia of the carotid sheath.
33.
The radical neck dissection is defined as removing all of the lymphatic tissue in regions I-V including removal of the spinal accessory nerve ( SAN ), sternocleidomastoid muscle ( SCM ), and internal jugular vein ( IJV ).
34.
Hence, weakness of shrug on one side and head-turning on the other side may indicate damage to the accessory nerve on the side of the shrug weakness, or damage along the nerve pathway at the other side of the brain.
35.
The only nerves containing SVE fibers are cranial nerves : the trigeminal nerve ( V ), the facial nerve ( VII ), the glossopharyngeal nerve ( IX ), the vagus nerve ( X ) and the accessory nerve ( XI ).
36.
The transverse ligament divides the ring of the atlas into two unequal parts : of these, the posterior and larger serves for the transmission of the medulla spinalis and its membranes and the accessory nerves; the anterior and smaller contains the odontoid process.
37.
In 1848, Jones Quain described the nerve as the " spinal nerve accessory to the vagus ", recognizing that while a minor component of the nerve joins with the larger vagus nerve, the majority of accessory nerve fibers originate in the spinal cord.
38.
The accessory nerve is directed obliquely across the space from the Sternocleidomastoideus, which it pierces, to the under surface of the Trapezius; below, the supraclavicular nerves and the transverse cervical vessels and the upper part of the brachial plexus cross the space.
39.
The eleventh or spinal accessory nerve corresponds to a line drawn from a point midway between the angle of the jaw and the mastoid process to the middle of the posterior border of the sterno-mastoid muscle and thence across the posterior triangle to the deep surface of the trapezius.
40.
Weakness in head-turning suggests injury to the contralateral spinal accessory nerve : a weak leftward turn is indicative of a weak right sternocleidomastoid muscle ( and thus right spinal accessory nerve injury ), while a weak rightward turn is indicative of a weak left sternocleidomastoid muscle ( and thus left spinal accessory nerve ).
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