The Transverse Cervical Vessels

The transverse cervical artery and vein constitute important anatomical landmarks in the posterior triangle of the neck. The transverse cervical artery is one of the branches of the thyrocervical trunk. The variations in the branches and the exact manner of branching of the thyrocervical trunk are numerous (Fig. 4-39). However, the prevailing patterns usually show at least one branch that runs almost transversely across the neck, anterior to the anterior scalene muscle and the brachial plexus (Fig. 5-21).

The transverse cervical artery is usually accompanied by a vein. Both are found within the fibrofatty tissue of the supraclavicular fossa and often may be preserved during functional neck dissection. However, there is an inconstant ascending branch from the thyrocervical trunk that usually must be ligated and divided to allow a complete dissection of the supraclavicular fossa. This ascending cervical artery may arise from the inferior thyroid artery or from other arteries at the base of the neck, and it is frequently represented by more than one vessel.

Figure 5-18 Spinal accessory maneuver on the right side. (A). The fibrofatty tissue of the upper spinal accessory region has been dissected from the deep muscular floor. (B). The dissected tissue has been passed beneath the nerve to join the specimen coming from the submandibular area. sa, spinal accessory nerve; ls, levator scapulae muscle; IJ, internal jugular vein; hn, hypoglossal nerve; SC, sternocleidomastoid muscle; SS, specimen from the upper spinal accessory region; SJ, specimen from the upper jugular and submandibular area.

Figure 5-18 Spinal accessory maneuver on the right side. (A). The fibrofatty tissue of the upper spinal accessory region has been dissected from the deep muscular floor. (B). The dissected tissue has been passed beneath the nerve to join the specimen coming from the submandibular area. sa, spinal accessory nerve; ls, levator scapulae muscle; IJ, internal jugular vein; hn, hypoglossal nerve; SC, sternocleidomastoid muscle; SS, specimen from the upper spinal accessory region; SJ, specimen from the upper jugular and submandibular area.

Figure 5-19 The spinal accessory maneuver is completed and the specimen has been dissected from the upper part of the internal jugular vein on the left side.

A final cut is made below the spinal accessory nerve (-----). SC, sternocleidomastoid muscle; sa, spinal accessory nerve; IJ, internal jugular vein; hn, hypoglossal nerve; dm, digastric muscle; el, ear lobule; S, specimen from the upper jugular and spinal accessory area.

Figure 5-19 The spinal accessory maneuver is completed and the specimen has been dissected from the upper part of the internal jugular vein on the left side.

A final cut is made below the spinal accessory nerve (-----). SC, sternocleidomastoid muscle; sa, spinal accessory nerve; IJ, internal jugular vein; hn, hypoglossal nerve; dm, digastric muscle; el, ear lobule; S, specimen from the upper jugular and spinal accessory area.

Figure 5-20 Before approaching the supraclavicular area, a final downward cut is made anterior to the sternocleidomastoid muscle (-----). This cut extends approximately 2 cm below the spinal accessory nerve and should be carried deep to the levator scapulae muscle (right side). SC, sternocleidomastoid muscle; sa, spinal accessory nerve; S, specimen from the upper spinal accessory region.

Figure 5-20 Before approaching the supraclavicular area, a final downward cut is made anterior to the sternocleidomastoid muscle (-----). This cut extends approximately 2 cm below the spinal accessory nerve and should be carried deep to the levator scapulae muscle (right side). SC, sternocleidomastoid muscle; sa, spinal accessory nerve; S, specimen from the upper spinal accessory region.

Nerve Dermatitis
Figure 5-21 Right supraclavicular fossa after removal of its lymphatic contents. CS, carotid sheath; pn, phrenic nerve; tv, transverse cervical vessels; oh, omohyoid muscle; SC, sternocleidomastoid muscle.
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