Anatomical study and clinical significance of anterior surgical approach to the cervico-thoracic junction

Abstract

Objective: To study the anatomical relationship between the cervico-thoracic junction (CTJ) and adjacent structures in anterior surgical approach, and to measure the related anatomical parameters for clinical application of the anterior surgical approach to the cervico-thoracic junction. Methods: Ten Chinese adult cadavers were dissected, simulating the anterior surgical approach. After the manubrium of sternum was split, the exposure area and anatomical structures were studied, and the related anatomical parameters were measured. Results: The right recurrent laryngeal nerve reached the tracheoesophageal groove at the level up the lower part of C7 in all cadavers, the entry point was high and variable. In all cadavers the left recurrent laryngeal nerve run within the tracheoesophageal groove from the entry point at the level below the lower part of T3, and the position was more constant. The confluence point of bilateral brachiocephalic veins was variable, in 4 cases it was found at the posterior of the right first sternocostal joint, 4 at the first intercostal space near the right margin of sternum, and 2 at the posterior of the second sternocostal joint. In 7 cadavers the thoracic duct converged into the venous system from C7-T 1 disc to the upper part of T2. Conclusion: An adequate exposure from C3 to T3 can be obtained in the anterior surgical approach. The confluence point of bilateral brachiocephalic veins plays a key role in the surgical exposure. A left anterior surgical approach could cause less injury to the recurrent laryngeal nerve, and attention should be paid to protect the thoracic duct.