Relationship between the ansa cervicalis and the omohyoid muscle: clinical consequences in parathyroid surgery

Abstract

To determine the position of the lower loop of the ansa cervicalis (AC) compared to the inferior edge of the omohyoid muscle to guide minimally invasive surgery for the lateral oblique approach of parathyroid glands. Authors performed 36 anatomical dissections in the laboratory of anatomy (Laboratoire d'Anatomie Des Alpes Françaises) of the Grenoble medical school in 2012 on human cadavers. They independently measured the distance between the caudal extremity of the AC and the lower edge of the superior belly of the omohyoid muscle. Then, they controlled this measure on pictures. The study shows a majority of long AC (under the omohyoid muscle) in 66.7% of cases. In addition, the AC was located on an average value of 0.1cm below the lower edge of the omohyoid muscle (median -0.5cm). Thus, two-thirds of AC are between 0 and -2cm under the omohyoid muscle. Furthermore, the AC is generally non-symmetrical: there is a mean difference of 1.3cm between the left and right AC. In this series, there are as many long AC on the right side as on the left side. These results are in contradiction with literature data. To preserve the ansa cervicalis and its phonatory functions, it is necessary for the surgeon to perform a systematic per operative identification of the AC because the position of the AC is mainly under the omohyoid muscle and because of an asymmetry. Per operative neurostimulation and/or magnified lenses might be helpful during the surgical approach.