Radical neck dissection: preserving the distal spinal accessory nerve based on its cervical plexus contribution

Area of Science:

• Head and Neck Surgery
• Surgical Oncology
• Anatomy

Background:

• Radical neck dissection can cause significant shoulder dysfunction due to spinal accessory nerve (XI) sacrifice.
• Existing nerve-preserving modifications may compromise oncological safety in cases of extensive metastasis.

Purpose of the Study:

• To describe a modified technique for radical neck dissection that preserves spinal accessory nerve function while maintaining oncological safety.
• To reduce shoulder morbidity associated with classical radical neck dissection.

Main Methods:

• A surgical technique preserving the XI nerve based on cervical plexus contribution is detailed.
• Allows en bloc resection of the proximal XI nerve with metastatic lymph nodes.
• Focuses on selective nerve preservation in head and neck cancer surgery.

Main Results:

• The described modification aims to preserve useful trapezius muscle function.
• The technique is designed to be oncologically safe even with metastatic upper jugular nodes and extracapsular spread.
• Potential to reduce postoperative shoulder dysfunction.

Conclusions:

• This modified neck dissection technique offers a balance between functional preservation and oncological control.
• It represents a viable option for select head and neck cancer patients requiring neck dissection.
• Further studies may validate functional outcomes and oncological efficacy.