Clinical Significance And Its Anatomy Study On Anterior Approach Of The Cervical

[Objective] To dissect the important structures of the anterior cervical triangle, make a progress in mastering the spatial relationship of the important structures at this area and the courser and variation of the blood vessels and the nerves.[Methods] In 40 sides of 20 adult cadavers that were fixed by formalin, the important structures in front of the cervical vertebra were dissected,observed and measured, the results were analyzed by the SPSS10.0 software.[Results]1. The left laryngeal nerve that was sent out by the cranial nerve at the T4 altitude went up to the cervical region, went through in the tracheo-asophageal sulcus and was totally covered by the visceral fascia. The right laryngeal nerve wasn't totally covered by the visceral fascia, its upper part was in the visceral fascia, its downward part was out of the visceral fascia. The right laryngeal nerve didn't go into the tracheo-asophageal sulcus immediately after it went into the visceral fascia, but it went up firstly by stricking in the inner wall of the fascia, then it went into the tracheo-asophageal sulcus at the C6-7 intervertabra.2. The measurement of the truncus sympathicus cervicalis and the collilongus 2.1 the distance of the truncus sympathicus cervicalis and the medial border of the collilongus C3 (23.4±4.7)mm, C4 (19.5±3.8)mm,C5 (17.5±5.6)mm, C6 (14.6±4.8)mm, C7 (12.4±2.9)mm. 2.2 the distance of the truncus sympathicus cervicalis and the anterior median line C3(26.8±3.3)mm,C4(26.1±4.2)mm,C5 (24.7±2.8)mm, C6 (22.6±3.9)mm, C7 (18.7±2.6)mm. 2.3 the angle of the truncus sympathicus cervicalis to the medial border of the collilongus,the angle of the truncus sympathicus cervicalis to the anterior median lineThe angle of the left truncus sympathicus cervicalis to the anterior median line was 10.3°±3.5,the right was 11.5°±4.2. The angle of the left truncus sympathicus cervicalis to the medial border of the collilongus was 17.8°±4.7, the right was 17.3°±5.8, the data was dealt with statistically, there weren't statistical difference in both sides.3. 40 sides specimens were observed in the paper, all the vertebral artery sent out from the subclavian artery, went to the introversion in the vertebral artery triangle, it came in the transverse foramen of C6 in 38 sides (95%), it came in the transverse foramen of C5 in 2 sides (5%). The distance of the initial part of the vertebral artery to the transverse foramen of C6 was(46.89±16.53)mm. There weren't statistical difference in both sides(p>0.05). The distance of the vertebral artery to the medial border of the collilongus at the C6 altitude was (8.38±1.57)mm, the part that the vertebral artery went through in the transverse foramen was called vertebrae segment, The distance of the vertebral artery to the anterior median line at the C3~C6 level: C3 (13.6±1.5) mm, C4 (13.4±1.7) mm,C5 (14.6±1.5)mm,C6 (17.3±2.4)mm. The angle of the vertebral artery to the medial border of the anterior scalenus muscle was 23.87°±3.26. There weren't statistical difference in both sides(p>0.05). [Conclusion]①The left laryngeal nerve goes through in the tracheo-asophageal sulcus and is totally covered by the visceral fascia. In the operation of the cervical anterior approach that is operated out the visceral fascia, as the left laryngeal nerve isn't dragged too excessively, it won't be injured. But the right laryngeal nerve isn't totally covered by the visceral fascia. In the operation this trait should be noted in order to reduce the lesion of the laryngeal nerve.②The distance of the truncus sympathicus cervicalis to the anterior median line is nearest at the C6-7 intervertabra. The surgery should master the trait of the truncus sympathicus cervicalis when they are doing the operation through the downward cervical anterior approach, and they should avoid injuring the truncus sympathicus cervicalis when they are stripping the collilongus.③The segment that the initial part of the vertebral artery to the transverse foramen of C6 is deep, and it locates in the interspace that is surrounded by the collilongus,the anterior scalenus muscle,the subclavian artery. In order to avoid injuring the vertebral artery, the collilongus and the anterior scalenus muscle can be considered the sign of location to the vertebral artery, the security area of the operation can be determined.