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Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus III: Nervous System: Plexuses: Phrenic Nerve

Illustrated Encyclopedia of Human Anatomic Variation: Opus III: Nervous System: Plexuses

Phrenic Nerve

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed


The following variations in origin, course, and distribution of the phrenic nerve have been reported. The phrenic nerve may receive additional roots from one or more of the following nerves: nerve to subclavius; nerve to sternohyoid; second or rarely, sixth cervical nerve; descendens cervicalis; ansa cervicalis; and brachial plexus.

 

It may receive a branch from CN XII (hypoglossal) and may communicate with CN XI (spinal accessory).

The phrenic nerve may arise exclusively from the nerve to subclavius.

On occasion it supplies a branch to the subclavius muscle.

The phrenic may pass along the lateral border of or pierce the anterior scalene muscle.

The consolidation of the phrenic into a single trunk may not occur until it enters the thorax. The size of the nerve may vary bilaterally.

Instead of descending behind the subclavian vein the phrenic may pass anterior to it or even through a ring or annulus formed by the vein.

An accessory phrenic nerve may also arise from the fifth or fifth and sixth cervical nerves and pass in front or behind the subclavian vein to join the main trunk of the phrenic nerve at the root of the neck or within the thorax. The incidence of an accessory phrenic nerve was reported to be 75% in 309 cases studied.

The phrenic nerve may supply a branch to scalenus anterior.

The phrenic nerve may descend in contact with the posterior surface of the sternocleidomastoid, cross in front of the subclavian and right brachiocephalic veins, and lie about 1.5 cm in front of the scalenus anterior muscle and subclavian artery. In one case, the right phrenic was found passing through an annulus of the subclavian vein.

Origin of Accessory Phrenic Nerve
from Yano, 1925

Accessory Phrenic Nerve

Author

No. Body Halves

No. of Cases

Percent

Vagus Nerve

Wrisburg

Luschka

37

32

1

0

2.7%

-

Accessory Nerve

Blandin

Henle

Unclear

1

-

-

Suprascapular Nerve

Casali

Unclear

1

-

-

Ansa Hypoglossi

Wrisburg

Haller

37

Unclear

5

5

14%

-

Nerve to Subclavius

Willy Felix

Goetze

Ruhemann

Yano

Unclear

25

17

22

3

12

5

12

18%

48%

32%

55%

Spinal Accessory, From C5

Willy Felix

Goetze

Ruhemann

Hara

Yano

Unclear

25

17

Unclear

22

Unclear

8

6

4

5

20%

32%

35%

-

23%

Image 44

Accessory Phrenic Nerve from the Nerve to Subclavius Muscle

Accessory Phrenic Nerve from the Nerve to Subclavius Muscle

Accessory Phrenic Nerve from the Nerve to Subclavius Muscle

Accessory Phrenic Nerve from the Nerve to Subclavius Muscle


References

Bertelli, D. (1933-34) Distribuzione dei nervi frenici nel diaframma dei Mammiferi. Arch. Ital. Anat. Embriol. 32:110-148.

Felix, W. (1922) Anatomische, experimentelle und klinische Untersuchungen über den N. phrenicus und über die Zwerchfellinnervation. Deutsche Z. Chir. 171:283-397.

Felix, W. (1922) über den Nervus phrenicus und die Zwerchfellinnervation. Zentralbl. Chir. 49:1832.

Felix, W. (1922) Anatomische, experimentalle und klinische Untersuchungen über den Phrenicus und über die Zwerchfellinnervation. Deutsche Zeitschrift für Chirurgie 171:283-397.

Fontes, V. (1955) Les origines du nerf phrénique. Assoc. Anatomistes Comptes Rendus 42:518-526.

Greenfield, J. and G.M. Curtis. (1942) The "sniff test" in thoracic surgery. With a review of 119 phrenic nerve interruptions. J. Thoracic Surg. 12:79-85.

Haro, S. (1907) Ueber einige klinisch sehr wichtige Verlaufsanomalien des N. phrenicus. Tokyo Journal Medical Sciences 21(4):21-29.

Jaya, Y. (1960) Liver as a content of the right sided diaphragmatic hernia - A case report. J. Anat. Soc. India 9:37-38.

Kelley, W.O. (1950) Phrenic nerve paralysis. Special considerations of the accessory phrenic nerve. J. Thoracic Surg. 19:923-928.

Kiss, F. and H.C. Ballon. (1925) Contribution to the nerve supply of the diaphragm. Anat. Rec. 41:285-298.

Larkin, F.C. (1889) Accessory phrenic nerve. J. Anat. Physiol. 23:340.

Minne, J., Senneville, A. et Y. Guyot. (1949) Remarques sur la division et les branches terminales du nerf phrenique droit. Assoc. Anatomistes Comptes Rendus 36:484-491.

Oliver, E., Minne, -., -. Rocquet. (1926) La traversée diaphragmatique du nerf phrénique droit et ses variations. Assoc. Anatomistes Comptes Rendus 21:441-444.

Ono, N. (1934-35) Untersuchungen und Studien über die Ursprungszellen des N. phrenicus. Jpn. J. Med. Sci. 5:1-34.

Prioton, J.B. and A. Thevenet. (1957) La distribution intra-diaphragmatique des nerfs phréniques. Assoc. Anatomistes Comptes Rendus 44:635-645.

Ruhemann, E. (1926) Die Topographie des Nervus phrenicus unter abnormen Verhältnissen. Arch. Klin. Chirurgie 139:557-562.

Schaefer, E.A., Symington, J. and T.H. Bryce., Eds. (1915) Quain's Anatomy, 11th ed., Longmans, Green, and Co., London.

Sauerbruch, F. (1913) Die Beeinflussung von Lungenerkrankungen durch künstliche Lähmung des Zwerchfells (phrenikotomie). Münch. Med. Wochenschr. 60:625-626.

Turner, W. (1893) A phrenic nerve receiving a root of origin from the descendens hypoglossi. J. Anat. Physiol. 27:427.

Van der Stricht, J. (1950) A propos d'une anomalie du nerf phrénique. Assoc. Anatomistes Comptes Rendus 37:478-484.

Vieussens, R. (1664) Neurographia universalis. Lugduni.

Wernicke, -. (1897) Insuffizienz der Nervi phrenici. Monatsschar. f. Psych. und Neurol. 2:200.

Wrisberg, L. (1780) De nervis viscerum abdominalium. Secto. I. De nervo diaphragmatico. Gottingae.

Yano, K. (1925) Zur Anatomie des Nervus pherincus und Nebenphrenicus. Folia Anatomica Japonica 3(3):95-106.

Yano, K. (1928) Zur Anatomie und Histologie des Nervus phrenicus und sogenannten Nebenphrenicus, nebst Bemerkungen uber ihre Verbindung mit Sympathicus. Folia Anat. Jpn. 6:247-290.

Ziemessen, -. (1882) Erregbarkeit des N. phrenicus. Arch. f. Klin. Med. 30:270.

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