Considering the spinal accessory nerve in head and neck surgery.

Area of Science:

• Head and Neck Surgery
• Reconstructive Surgery
• Oncology

Background:

• Trapezius muscle dysfunction is a significant long-term complication following radical neck dissection.
• Preservation of the trapezius muscle is a key goal in modified neck dissection techniques.

Purpose of the Study:

• To evaluate trapezius muscle function in patients after various radical neck dissection techniques.
• To assess the functional outcomes related to spinal accessory nerve management during neck dissection.

Main Methods:

• A retrospective evaluation of 100 patients who underwent composite resection for head and neck cancer.
• Assessment of trapezius muscle function and symptoms at a mean of 6.2 years post-surgery.
• Comparison of outcomes following radical neck dissection with spinal accessory nerve sacrifice, preservation, or cable graft reconstruction.

Main Results:

• 67% of patients with spinal accessory nerve sacrifice had minimal trapezius-related symptoms despite significant muscle atrophy.
• 20% of patients with spinal accessory nerve preservation exhibited poor trapezius muscle function.
• Interpositioned nerve grafts were functional in 66% of patients.

Conclusions:

• A substantial number of patients undergoing radical neck dissection with spinal accessory nerve sacrifice experience minimal functional deficits.
• Trapezius muscle dysfunction can occur even when the spinal accessory nerve is preserved, indicating complex functional outcomes.