[Preserving the accessory nerve in neck dissection]

A total of 104 patients who had undergone neck dissection were examined with respect to disturbance of shoulder function on the operated side. The accessory nerve had been severed in half the patients and preserved in the other half. A dynamo-meter was used to measure the force a patient standing upright could exert in pulling upward with his arm outstretched. The relative loss of strength after neck dissection was determined by relating the difference between the two sides to the strength of the healthy shoulder. On average, the loss of strength in the operated shoulder was significantly less after preservation of the accessory nerve than after its severance. An additional influence due to tumour stage or postoperative irradiation was not found. The functional loss determined by the difference quotient correlated well with the patients' subjective account of their functional impairment. Preservation of the eleventh cranial nerve is discussed with respect to the question of increased risk of lymph node recurrence.