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OJHAS: Vol. 5, Issue
1: (2006 Jan-Mar) |
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Axillary Arch (Of Langer): Incidence, Innervation, Importance |
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Mangala M
Pai
Assistant Professor
Rajanigandha
Assistant Professor
Latha V Prabhu
Professor
Prakash Shetty
Associate Professor
Narayana K
Assistant Professor
Department of Anatomy, Center
for Basic Sciences,
Kasturba Medical College, Bejai, Mangalore- 575004,
Karnataka, India. |
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Address For Correspondence |
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Dr. Prakash Shetty
Department of Anatomy, Center
for Basic Sciences,
Kasturba Medical College,
Bejai, Mangalore- 575004,
Karnataka, India.
E-mail:
docprakashshetty@yahoo.co.in |
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Pai MM, Rajanigandha, Prabhu LV, Shetty P, Narayana K. Axillary Arch (Of Langer): Incidence, Innervation, Importance.
Online J Health Allied Scs.2006;1:4 |
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Submitted: Feb 01,
2006; Suggested Revision: May 16, 2006; Revised: May 22, 2006; Accepted:
May 31, 2006; Published:
Jul 08, 2006 |
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| Abstract: |
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The present study was planned
to find out the incidence of accessory muscle arches in the axilla of
68 upper limb (38 right and 30 left) dissections. Langer’s arch was
observed in one right limb out of the 68 limbs, total incidence was
1.47%. The arch extended from the latissimus dorsi to the fascia covering
the biceps brachii. The incidence is low in South Indian population
(Dravidians) compared to the various other populations reported in literature.
A branch from the lateral cord of brachial plexus supplied it in contrast
with the previous reports. The surgical significance of this muscle
is reviewed.
Key Words:
Axilla, Accessory
muscles, Biceps, Lymphadenectomy, Neurovascular bundle. |
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Variable muscle slips such
as chondro-epitrochlearis, dorso-epitrochlearis, Costo-corocoideus or
axillary arches are occasionally encountered in the axilla.(1) It measures
7-10 cm in length and 0.5-1.5cm in breadth, and extends from the edge
of latissimus dorsi to the pectoralis major, or coracobrachialis or
to the fascia covering the biceps brachii.(2) It may be a single band
like structure, or may be found as multiple bands and known to be present
in 7% of Japanese subjects.(3) Its occurrence is still higher, around
10% in Belgian subjects(4), however, on the other hand surprisingly
as low as 0.25% in British.(5) This indicates that, the incidence of axillary arch varies in different races though the incidence is unknown
in Indians. The present study was planned to evaluate the incidence
of axillary arch in cadavers of South Indian origin.
This study was conducted in
68 (38 right and 30 left) upper limb dissections. The muscular arch
was dissected from its origin to insertion. The nerve twig supplying
it was dissected.
The axillary arch was present
in one right upper limb (2.63%) and if the 68 limbs were considered, the
incidence was 1.47%. The muscular slip originated from the latissimus
dorsi and inserted into the fascia covering the short head of biceps
brachii. A branch from the lateral cord supplied it.
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Photograph of right axilla showing the muscular axillary arch (lower
arrow) extending from the latissimus dorsi to the fascia covering the biceps brachii.
Note that a branch (upper arrow) from the lateral cord is supplying the arch. The
arch has crossed superficial to the neurovascular bundle near its attachment. |
Previous studies on axillary
arches have revealed that it is a variable structure with the incidence
ranging from 0.25% (5) to 10%.(4) The incidence of this arch in the
present study (1.47%) is well within the range given above. Based on
the formation and nerve supply, Takafuje et al (6) classified
the arches into 8 different types. The present case does not fit into
their classification since it was not supplied either by the thoracodorsal
or medial pectoral nerve or caudal pectoral nerve (branch of medial
pectoral nerve). In this study a branch from the lateral cord supplied
the arch.
Since the arch crosses superficial
to the neurovascular bundle in the axilla, it could compress them, especially
during abduction and lateral rotation of the shoulder joint. Thus it
could obstruct the axillary vessels, particularly the vein.(7) Some
authors have discussed its importance in differential diagnosis of thoracic
outlet and shoulder instability syndromes.(4) It should also be considered
in differential diagnosis of axillary swellings and the construction
of latissimus dorsi flaps.(5)
The axillary arch should be
recognized and excised to expose the axillary artery and vein in patients
with trauma and to perform axillary lymphadenectomy or axillary bypass.(8) According to Petrasek AJ et al (9), if an axillary arch
is encountered during axillary lymphadenectomy, the lymph nodes posterior
and lateral to the arch should be excised. The presence of this anomaly
preoperatively may be diagnosed by magnetic resonance axillography.(10) Simple excision of this muscle is curative.(7,8) Therefore, knowledge
of the anatomical variations in this area is necessary for surgical
interventions.
-
Brash JC. Cunninghams’
text book of Anatomy. 9th
edition, Oxford University Press, London;1951,pp 479.
- Salmons. Muscle. In: Grays’
anatomy. Eds: Churchill Livingstones, London, 1995; pp 836-837.
- Kasai T, Chiba S. True nature
of the muscular arch of the axilla and its nerve supply. Kaibogaku Zasshi
1977;25:657-669.
- Clarys JP, Barbaix E, Van
Rompaey H, Caboor D, Van Roy P. The muscular arch of the axilla revisited:
its possible role in the thoracic outlet and shoulder instability syndromes.
Man Ther 1996;1(3):133-139.
- Serpell JW, Baun M. Significance
of ‘Langer’s axillary arch’ in axillary dissection.
Aust N Z J Surg 1991;61(4):310-312.
- Takafuje T, IgarashiJ, Kanbayashi
T, Yokoyama T, Moriya A, Azuma S, Sato Y. The muscular arch of the axilla
and its nerve supply in Japanese adults. Kaibogaku Zasshi 1991;66(6):511-523.
- Sachatello CR. The axillopectoral
muscle (Langer’s axillary arch): a cause of axillary vein obstruction.
Surgery 1977;81(5):610-612.
- Miguel M, Llusa M, Ortiz
JC, Porta N, Lorente M, Gotzens V. The axillo pectoral muscle (of Langer):
report of three cases. Surg Radiol Anat 2001;23(5):341-343.
- Petrasek AJ, Semple JL,
McCready DR. The surgical and oncological significance of the
axillary arch during axillary lymphadenectomy. Can J Surg 1997;40(1):44-47.
- Suzuma T, Sakurai T, Yoshimura
G, Umemura T, ShimizuY, Yang GF, Okamura Y. Magnetic resonance axillography
for preoperative diagnosis of the axillopectoral muscle (Langer’s
axillary arch): a case report. Breast Cancer 2003;10(3):281-283.
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