Archives of Head and Neck Surgery
Archives of Head and Neck Surgery
Original Article

Ansa cervicalis or ansa hypoglossi? A systematic review

Gustavo Henrique Pereira Boog, Flávio Carneiro Hojaij, Matheus Mychael Mazzaro Conchy, Renan da Silva Bentes, Flávia Emi Akamatsu, Alfredo Luiz Jácomo

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Introduction: The ansa cervicalis, commonly called ansa hypoglossi, is a loop of nerves that composes the cervical plexus. The term ansa hypoglossi derives from the anastomosis between this loop and the hypoglossal nerve (cranial nerve XII). In the study of Anatomy, discrepancies between the anatomical terminology and the terms used in medical practice are frequent. However, a discussion becomes necessary when these divergences arise from conceptual errors. Objective: To conduct a literature review on the relationship between the ansa cervicalis (or ansa hypoglossi) and the hypoglossal nerve, discussing this disparity in terminology, and determine which of these terms is the most suitable to identify this important nerve structure. Methods: This is a systematic review of the literature based on studies found through a standardized search performed at the LILACS and MEDLINE/PUBMED databases; classic anatomy textbooks were also consulted. Results: Forty-five of the 3731 articles found in the scientific research databases were selected and six classic anatomy textbooks were included in the study. Controversies involving the ansa cervicalis were analyzed and the results clearly showed that most textbooks describe its relationship with the hypoglossal nerve as a temporal junction, with no exchange of nerve fibers. The ansa cervicalis contains fibers arising from the cervical cord, and not from the hypoglossal nerve. Conclusion: The term ansa cervicalis should be chosen to name this loop of nerves. The term ansa hypoglossi is not structurally correct, and should be abandoned in medical practice, the teaching of anatomy, and in scientific publications


anatomy; cervical plexus; hypoglossal nerve; terminology.


1. Netter FH. Atlas de anatomia humana. 6. ed. Rio de Janeiro: Elsevier; 2015.

2. Schunke M, Schulte E, Schumacher U. Prometheus, atlas de anatomia: pescoço e órgãos internos. 1. ed. Rio de Janeiro: Guanabara Koogan; 2007.

3. Paulsen F, Waschke J. Sobotta atlas de anatomia humana. 23. ed. Rio de Janeiro: Guanabara Koogan; 2012.

4. Standring S. Gray’s anatomy: the anatomical basis of clinical practice. 41st ed. New York: Elsevier Health Sciences; 2015.

5. Hollinshead WH. Anatomy for surgeons: the head and neck. 3rd ed. New York: Harper; 1982.

6. Moore KL, Dalley AF, Agur AMR. Moore anatomia orientada para a clínica. 7. ed. Rio de Janeiro: Guanabara Koogan; 2014.

7. Cloquet JH. Manuel d’anatomie descriptive du corps humain. Paris: Béchet; 1825.

8. Bach CE. Annotationes anatomicae de nervis hypoglosso et laryngeis. Zurich: Orell Füssli; 1835.

9. Donath T. Erläuterndes anatomisches Wörterbuch vergleichende Übersicht der Baseler, Jenaer und Pariser Nomenklaturen, gruppiert nach Organen. Budapest: Terra, Verlag Medicina; 1960.

10. Federative Committee on Anatomical Terminology. Terminologia Anatomica: International Anatomical Terminology. New York: Thieme; 1998.

11. Iaconetta G, Solari D, Villa A, Castaldo C, Gerardi RM, Califano G, Montagnani S, Cappabianca P. The hypoglossal nerve: anatomical study of its entire course. World Neurosurg. 2018;109:486-92. PMid:29032218.

12. Hall-Craggs ECB. Anatomy as a basis clinical medicine. 2nd ed. Baltimore: Urban & Schwarzenberg; 1990.

13. Caliot P, Dumont D, Bousquet V, Midy D. A note on the anastomoses between the hypoglossal nerve and the cervical plexus. Surg Radiol Anat. 1986;8(1):75-9. PMid:3088750.

14. Sinnatamby CS. Last’s anatomy: regional and applied. 10th ed. London: Elsevier Churchill Livingstone; 1999.

15. Kikuchi T. A contribution to the morphology of the ansa cervicalis and the phrenic nerve. Acta Anat Nippon. 1970;45(5):242-81. PMid:5530030.

16. Banneheka S. Anatomy of the ansa cervicalis: nerve fiber analysis. Anat Sci Int. 2008;83(2):61-7. PMid:18507614.

17. Pillay P, Partab P, Lazarus L, Satyapal KS. The ansa cervicalis in fetuses. Int J Morphol. 2012;30(4):1321-6.

18. Sakamoto Y. Morphological features of the branching patterno of the hypoglossal nerve. Anat Rec (Hoboken). 2019;302(4):558-67. PMid:29659197.

19. Banneheka S, Tokita K, Kumaki K. Nerve fiber analysis of ansa cervicalis-vagus communications. Anat Sci Int. 2008;83(3):145-51. PMid:18956786.

20. Salame K, Masharawi Y, Rochkind S, Arensburg B. Surgical anatomy of the cervical segment of the hypoglossal nerve. Clin Anat. 2006;19(1):37-43. PMid:16187305.

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