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The preservation of shoulder function after radical neck dissection.
Clinical Otolaryngology and Allied Sciences
|April 1, 1985
Summary
Radical neck dissection can cause shoulder syndrome by damaging the spinal accessory nerve. A new surgical technique preserves nerves, significantly improving shoulder function in patients.
Area of Science:
- Head and Neck Surgery
- Surgical Anatomy
- Neurosurgery
Background:
- Radical neck dissection (RND) is a common surgical procedure for head and neck cancers.
- A significant complication of RND is 'shoulder syndrome,' characterized by trapezius muscle dysfunction.
- This dysfunction results from the division of the spinal accessory nerve (SAN), crucial for trapezius innervation.
Purpose of the Study:
- To investigate the cervical spinal nerve supply to the trapezius muscle.
- To develop and evaluate a modified RND technique that preserves this nerve supply.
- To compare shoulder function outcomes between the modified RND and classical RND.
Main Methods:
- Cadaveric dissections were performed to meticulously study the anatomy of the cervical spinal nerves innervating the trapezius.
- Intraoperative stimulation of identified cervical spinal nerves during RND was conducted to confirm their motor function on the trapezius.
- A modified RND technique was developed based on anatomical findings, focusing on nerve preservation.
- Patient outcomes were compared between those who underwent the modified RND and those who had the classical RND.
Main Results:
- Cadaver dissections revealed viable cervical spinal nerve pathways to the trapezius muscle.
- Stimulation confirmed that these cervical spinal nerves provide motor innervation to the trapezius.
- The modified RND technique successfully preserved these critical nerves during dissection.
- Patients undergoing the modified RND demonstrated superior shoulder function compared to those who had the classical RND.
Conclusions:
- The trapezius muscle receives motor innervation from cervical spinal nerves in addition to the spinal accessory nerve.
- A modified radical neck dissection technique can preserve these cervical spinal nerves.
- This nerve-preserving approach significantly mitigates the incidence and severity of shoulder syndrome post-RND.
- The modified RND offers improved functional outcomes for patients undergoing neck dissection.