Shoulder disability after different selective neck dissections (levels II-IV versus levels II-V): a comparative study

Area of Science:

• Head and Neck Surgery
• Oncology
• Neurology

Background:

• Head and neck carcinoma treatment often involves neck dissection, potentially impacting shoulder function.
• Different selective neck dissection (SND) techniques carry varying risks of shoulder morbidity.

Purpose of the Study:

• To compare clinical and electrophysiological shoulder function outcomes after concomitant primary and neck surgery for head and neck carcinoma.
• To evaluate the impact of different selective neck dissection levels (II-IV vs. II-V) on shoulder function.

Main Methods:

• Retrospective study of 40 patients undergoing SND for head and neck carcinoma.
• Patients were divided into two groups: Level II-IV SND (Group A) and Level II-V SND (Group B).
• Shoulder function was assessed at least 1 year post-surgery using questionnaires, clinical exams, strength/motion tests, EMG, and electroneurography.

Main Results:

• Group B (II-V SND) showed higher rates of shoulder strength impairment (20%), motor deficit (15%), and pain (15%) compared to Group A (0%, 5%, 15%).
• Clinical signs like shoulder droop were more frequent in Group B (30%).
• Electromyography revealed significantly more abnormalities in Group B (85%) versus Group A (40%), indicating greater subclinical nerve impairment with wider dissections.

Conclusions:

• Clearance of the posterior triangle of the neck (levels II-V) is associated with increased shoulder morbidity.
• Subclinical nerve impairment is detectable even after less extensive SND (levels II-IV) if the submuscular recess is dissected.