23 Neurovascular techniques

One of the key propositions of the neck is that it allows free passage of numerous nerve fibers arising from the skull and the cervical column. These nerve fibers help to regulate the cardiovascular system, viscera of the neck such as the thyroid, and organs of the thorax, such as the heart and the lungs (Fig. 23.1).

Fig. 23.1 Neurovascular relationships.

In a somewhat simplified manner, we will describe a few manipulations for the neurovascular system of the neck. We will focus primarily on the glossopharyngeal, hypoglossal, vagus, and sympathetic cervical chain.

23.1 Glossopharyngeal nerve

The glossopharyngeal nerve is of interest because it innervates the carotid glomus and sinus. This nerve forms anastomoses with the:

• vagus nerve

• facial nerve

• sympathetic cervical chain: together with the superior cervical ganglion, it forms the intercarotid plexus.

Refer to Chapter 21 for the technique.

23.2 Hypoglossal nerve

This nerve was described in Chapter 15, in connection with the external carotid artery (Fig. 23.2). Multiple small branches run up and down the carotid artery. We search with our fingers for hardened fibers that do not glide smoothly on the artery wall.

Fig. 23.2 Carotid sinus.

The hypoglossal nerve forms anastomoses with the:

• superior cervical ganglion

• vagus nerve

• phrenic nerve

• cardiac plexus

• first two cervical nerves

23.3 Vagus nerve

There are various locations where this nerve can be manipulated in the neck. It can be accessed, for example, via the superior laryngeal nerve, the recurrent laryngeal, or the auricular branch at the external ear canal.

We described a technique for the superior laryngeal artery at the place where, together with the superior laryngeal nerve, it perforates the hyothyroid membrane (see Chapter 22).

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