Comparison of spinal accessory dysfunction following neck dissection with harmonic scalpel and electrocautery - A...

Harmonic scalpel is being increasingly used in neck dissection as alternative to conventional electro-cautery for achieving haemostasis. Use of harmonic scalpel has been shown to significantly reduce intra operative blood loss and intra operative time in neck dissection. But how safe is it with regards to nerve injury (spinal accessory nerve and other nerves) during neck dissection. We intended to study the spinal accessory nerve injury during neck dissection by both harmonic scalpel and electro cautery technique and compared postoperative recovery of shoulder function after neck dissection.

40 patients undergoing selective neck dissection for primary oral malignancy were enrolled in this study. The Harmonic scalpel (HS) group consisted of 20 patients, and the electo cautery technique (ET) group had 20 patients. The following variables were examined: shoulder pain by visual analog scoring and shoulder function by means of degree of abduction and graded was grade I-0-90°; grade II-90-135°; grade III-135-180°. They assessment was done at the time of discharge, 1month and 3month and six month after surgery.

Though shoulder pain was almost similar at 1st week and 1month, however at 2nd and 6th month shoulder pain was found to be significantly lesser in harmonic scalpel group as compared to electro cautery. At 1week more no of patients had restricted shoulder mobility in HS as compared to EC group. But at 6months the shoulder function was found to be significantly better in HS group as compared to EC group (p value<0.05).

Spinal accessory nerve function recovery after selective neck dissection is better in HS group as compared to the electro cautery group.