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Spinal accessory nerve function after neck dissections.
The Journal of Laryngology and Otology
|October 17, 2006
Summary
Functional neck dissection (FND) and radical neck dissection (RND) impact spinal accessory nerve function. EMG monitoring revealed nerve injury after FND, improving but not fully recovering by nine months post-surgery.
Area of Science:
- Neurosurgery
- Oncology
- Nerve Function Monitoring
Background:
- Head and neck cancer treatment often involves neck dissection.
- Spinal accessory nerve preservation is a goal in functional neck dissection (FND).
- Radical neck dissection (RND) typically results in more significant nerve impairment.
Purpose of the Study:
- To evaluate spinal accessory nerve function post-FND and RND using electromyographic (EMG) examinations.
- To compare shoulder function and patient-reported outcomes between FND and RND groups.
Main Methods:
- Prospective, double-blind clinical study involving 21 patients (42 neck dissections).
- Patients were divided into RND (10 sides) and FND (32 sides) groups.
- EMG examinations were performed pre-operatively and at 3 weeks, 3 months, and 9 months post-operatively. A modified neck dissection impairment index questionnaire was also used.
Main Results:
- Motor amplitudes decreased post-operatively in both groups, with more prominent decreases in the RND group.
- EMG amplitudes in the FND group improved over time but did not reach pre-operative levels by 9 months.
- The FND group reported significantly lower pain, stiffness, and disability compared to the RND group.
Conclusions:
- Despite anatomical preservation aims, FND surgery results in immediate spinal accessory nerve injury detectable by EMG.
- Nerve function shows improvement post-FND but remains suboptimal at 9 months.
- FND offers better shoulder function and patient-reported outcomes compared to RND, despite residual nerve deficits.
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