Clinical Image

Cardiothoracic Imaging: Unilateral Nerve of Kuntz

Natalie N Merchant1 and Osita Onugha2*
1Department of Medicine, David Geffen School of Medicine at UCLA, USA
2Department of Thoracic Surgery, John Wayne Cancer Institute, USA

*Corresponding author: Osita Onugha, Department of Thoracic Surgery, John Wayne Cancer Institute, 2121 Santa Monica Blvd, Cardiothoracic Outpatient Clinic, Santa Monica, CA 90404, USA

Published: 14 Jul, 2018
Cite this article as: Merchant NN, Onugha O. Cardiothoracic Imaging: Unilateral Nerve of Kuntz. Clin Surg. 2018; 3: 2026.

Clinical Image

A 21 year-old female received bilateral sympathectomy for axillary, palmer, and plantar hyperhydriosis. Intraoperative findings show unilateral Nerve of Kuntz (KN) branching off the 5th Thoracic nerve (T5) across rib 5 (R5) (Figure 1). This nerve is rarely found intraoperatively (~10%), but is commonly found on cadaveric anatomic dissection (~80%). The KN contributes to an alternate pathway to the brachial plexus and contributes to the clinical reasoning behind extending the ablation of thoracic nerves starting 2 cm away from the sympathetic ganglia [1,2]. Incomplete KN dissection has been blamed for poor surgical outcome and the failure rate for sympathectomy [3]. By resecting 2 cm away from the ganglia, the KN fibers are disrupted thereby achieving complete resection of sympathetic nerve fibers which contribute to the Pathophysiology of hyperhydriosis. For this patient, after ablating the T3, T4, T5 (including unilateral KN), this patient has had a successful surgical outcome.

Figure 1

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Figure 1
Intraoperative images demonstrates the relationship of Kuntz nerve and sympathetic chain. TS: Sympathetic Trunk; R4: rib 4; R5: rib 5; Arrow: Nerve of Kuntz


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