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Spinal accessory nerve preservation in modified neck dissections: surgical and functional outcomes
V Popovski1, A Benedetti1, D Popovic-Monevska1
1Clinic for Maxillofacial Surgery, St Cyril and Methodius University, Skopje, R. Macedonia.
Summary
Modified neck dissection preserves the spinal accessory nerve (SAN), reducing shoulder dysfunction. Preoperative imaging is crucial for identifying the SAN's variable path during neck surgery.
Area of Science:
- Neurosurgery
- Anatomy
- Surgical Oncology
Background:
- The spinal accessory nerve (SAN) is vulnerable during neck surgery, potentially causing shoulder dysfunction.
- Modified neck dissection (MND) aims to preserve the SAN and minimize functional deficits.
Purpose of the Study:
- To analyze intraoperative variations in the SAN pathway.
- To evaluate postoperative shoulder dysfunction after different neck dissection types.
Main Methods:
- Retrospective analysis of 165 patients undergoing neck dissections.
- Review of preoperative ultrasound/MRI, surgical records, and postoperative outcomes.
- Focus on SAN identification, dissection, and morbidity.
Main Results:
- The SAN is safest identified in the posterior neck triangle at Erb's point.
- Ultrasound and MRI are superior for preoperative planning of SAN location.
- MND showed significantly lower SAN morbidity (25%) compared to radical (46.7%) and selective (42.5%) dissections.
Conclusions:
- Accurate preoperative imaging is essential for identifying the SAN's course.
- MND offers comparable regional control with significantly reduced functional disability in selected patients.
Keywords:
Modified neck dissectionNeck metastasesPosterior neck triangleShoulder functionSpinal accessory nerve
