Antrochoanal polyps arise from the maxillary sinuses and are the much less common; ethmoidal polyps arise from the ethmoidal sinuses. Symptoms of polyps include nasal congestion, sinusitis, anosmia (loss of smell), and secondary infection leading to headache.
Relationship of internal jugular vein to the spinal accessory nerve (SAN). Spinal accessory nerve (SAN) posterior to the internal jugular vein. As the nerve approaches the sternocleidomastoid muscle (SCM), it may perforate the cleidomastoid portion of the SCM (80%) or run posterior to it (20%).
Cranial nerve X (vagus nerve). This nerve is mainly responsible for the ability to swallow, the gag reflex, some taste, and part of speech. The patient may be asked to swallow and a tongue blade may be used to elicit the gag response. Cranial nerve XI (accessory nerve). This nerve is involved in the movement of the shoulders and neck.