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Updated: Jul 15, 2026
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Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
Published on: March 1, 2015
The spinal accessory nerve in head and neck surgery.
Johnny Cappiello1, Cesare Piazza, Piero Nicolai
1Otolaryngology Department, University of Brescia, Piazza Spedali Civili 1, Brescia, Italy. cappiell@libero.it
Summary
Minimizing surgical trauma to the spinal accessory nerve (SAN) is crucial. Modified neck dissections reduce shoulder syndrome, but physical therapy is vital for nerve-sparing procedures, and SAN repair is recommended.
Area of Science:
- Head and Neck Surgery
- Neurosurgery
- Surgical Anatomy
Background:
- Radical neck dissection (RND) can lead to shoulder syndrome.
- Spinal accessory nerve (SAN) injury is a common cause of shoulder dysfunction post-surgery.
Purpose of the Study:
- To detail surgical landmarks and techniques to prevent SAN trauma.
- To outline management strategies for SAN injury.
Main Methods:
- Review of surgical literature on neck dissections and SAN anatomy.
- Analysis of outcomes following modified radical and selective neck dissections.
- Electromyography (EMG) studies to assess nerve function.
Main Results:
- Modified and selective neck dissections decrease shoulder syndrome prevalence compared to RND.
- Shoulder pain and limited mobility can occur even with nerve-sparing techniques, especially with Level V dissection.
- Physical therapy is essential for managing post-dissection shoulder dysfunction.
Conclusions:
- Subclinical SAN impairment is possible even after selective neck dissections (levels II-IV).
- Further research is needed to identify patients who may benefit from leaving sublevel IIB undissected.
- Early diagnosis of shoulder syndrome and SAN repair are recommended; newer techniques require more data.
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