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Year :2018
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Month :
March-April
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Volume :
7
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Issue :
2
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Page :
AO14 - AO19
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Pattern of Origin of Thoracic Splanchnic Nerves and their Clinical Implications for Sympathectomy and Splanchnicectomy-A Detailed Cadaveric Study
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Correspondence Address :
Thangaraj SP, Nagarajan Vishali,
Dr. Nagarajan Vishali,
Associate Professor, Department of Anatomy,
Ponnaiyah Ramajayam Institute of Medical Sciences,
ECR, Manamai-Nallur, Chennai-603102,Tamil Nadu,India.
E-mail: drvishalin@gmail.com
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Introduction: Introduction: The sympathetic nervous system, which is the larger autonomic division, includes the two ganglionated trunks and their branches, plexuses and subsidiary ganglia. The thoracic part of the sympathetic system has been a fascinating field in surgery for long time. Although, the thoracic part of the sympathetic system has thus been an area of importance for physicians and surgeons, the knowledge of this region also present lacunae. The important reasons for unsuccessful sympathectomy include sympathetic regeneration, alternate sympathetic pathways and variations in their presentation.
Aim: To investigate the origin and pattern of formation of the splanchnic nerves in order to establish a predictable pattern of splanchnic neural anatomy and to outline the surgical anatomy appropriate to effect adequate denervation of upper abdominal viscera.
Materials and Methods: The present study is done in 10 cadavers. The thoracic part of the sympathetic chain on both sides, their ganglia, the rami communicantes, the origin, course and exit of splanchnic nerves from thorax are dissected out with care, coloured with yellow and studied in detail which has been photographed and tabulated.
Results: Stellate ganglion was found in six sides. In two other sides 10 ganglia was found. Marked variations among the pattern of origin of Greater Splanchnic Nerve (GSN) with 14 different categories, Lesser Splanchnic Nerve (LSN) with seven different categories and Least Splanchnic Nerve (LeSN) with five different categories were observed in the present study. Also, the presence of two grey rami communicantes to the eleventh intercostal nerve and no grey ramus for subcostal nerve were observed.
Conclusion: The knowledge about the variations of the sympathetic chain, the number of ganglia present, the marked variations about the uncommon origin of splanchnic nerves provided with the current study are all important for the clinicians, surgeons to correlate for various surgical procedures required for the treatment of palmar hyperhidrosis, craniofacial hyperhidrosis, chronic pancreatitis and carcinomas of the pancreas, liver, gall bladder and stomach.
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