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J Thorac Cardiovasc Surg 2002;123:498-501
© 2002 The American Association for Thoracic Surgery

General Thoraic Surgery (GTS)

Anatomic variations of the T2 nerve root (including the nerve of Kuntz) and their implications for sympathectomy

From the Departments of Anatomy^a and Thoracic and Cardiovascular Surgery,^e Yonsei University College of Medicine, Seoul, Korea, the Department of Anatomy,^b Sungkyunkwan University School of Medicine, Suwon, Korea, the Department of Anatomy,^c Medical College, Konkuk University, Chungju, Korea, and the Department of Oral Biology,^d Yonsei University College of Dentistry, Seoul, Korea.

This study was supported by Brain Korea 21 Project for Medical Science, Yonsei University in 2001.

Received for publication June 4, 2001; revisions requested July 12, 2001; revisions received Aug 2, 2001; accepted for publication Aug 6, 2001. Address for reprints: In-Hyuk Chung, MD, PhD, Professor, Department of Anatomy, Yonsei University College of Medicine, Seodaemoonku Shinchondong 134, Seoul 120-752, Korea(E-mail: chinhy{at}yumc.yonsei.ac.kr

Objective: The aim of this study was to clarify the anatomic variations of the intrathoracic nerve of Kuntz, and this should help delineate the resection margins during video-assisted thoracic sympathectomy.
Methods: Sixty-six thoracic sympathetic chains of 39 adult Korean cadavers were dissected on both sides of the thorax in 27 cadavers (54 sides) and on one side in 12 cadavers (12 sides).
Results: The intrathoracic nerve was observed in 45 (68.2%) sides and was present bilaterally in 48.1% of cadavers. No intrathoracic nerve or ascending ramus communicans arising from the second thoracic nerve was observed in only 5 (7.6%) sides. The diameter of the intrathoracic nerve was 1.25 ± 0.55 mm on average. The arising point of the intrathoracic nerve from the second thoracic nerve was 7.3 mm on average from the sympathetic trunk. Presence of the stellate ganglion was noted in 56 (84.8%) sides, and 6 (9.1%) sides showed a single large ganglion formed by the stellate and the second thoracic sympathetic ganglia. The second thoracic sympathetic ganglion was most commonly located (50%) in the second intercostal space.
Conclusion: The anatomic variations of the intrathoracic nerve of Kuntz and the second thoracic sympathetic ganglion were characterized in human cadavers. It is hoped that this study will help to improve the recurrence of symptoms caused by the intrathoracic nerve in an upper thoracic sympathectomy for hyperhidrosis.

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