A 67-year-old female is admitted to the emergency department with a severe swelling on the right side of her neck. An MRI examination reveals an abscess. The abscess is surgically removed from the middle of the posterior cervical triangle on the right side. During recovery the patient notices that her shoulder droops and she can no longer raise her right hand above her head to brush her hair. Which of the following nerves has most likely been iatrogenically injured?
The spinal accessory nerve passes across the posterior triangle of the neck and innervates both the trapezius muscle and the sternocleidomastoid muscle for the respective side of the body. Upon surgical division of the nerve, the patient will lose the ability to raise the respective shoulder and will demonstrate weakness in turning the head to the opposite side. The trapezius will also lose tone and the shoulder will droop. The ansa cervicalis innervates strap muscles of the neck and, if cut, would not produce drooping of the shoulder. The facial nerve does not pass through any of the triangles of the neck; however, if it were divided, paralysis would result in the muscles of facial expression. The hypoglossal nerve innervates the intrinsic muscles of the tongue, plus the genioglossus, hyoglossus, and styloglossus and, if injured, would not result in any of the patient's symptoms.
Accessory
Ansa cervicalis
Facial
Hypoglossal
Head & Neck