Objective comparison of physical dysfunction after neck dissection

Thirty-five patients who underwent a total of 44 neck dissections of various types were prospectively studied to compare differences in postoperative shoulder function. Those who underwent a radical neck dissection suffered the greatest reduction in shoulder movement and had severely abnormal electromyograms. Those who underwent modified neck dissection with preservation of the spinal accessory nerve suffered less loss of shoulder function than the radical neck dissection group, but not to a significant degree at 16 weeks; however, the electromyograms of patients who underwent modified neck dissection were significantly better than those of the radical neck dissection group, which suggests that these patients may improve with time. Indeed, a reevaluation of several patients at 1 year showed improvement in both shoulder function and electromyograms in those who underwent modified neck dissection. Patients who underwent supraomohyoid neck dissection that involved minimal dissection of the spinal accessory nerve had minimal loss of shoulder function and usually, normal electromyograms at 16 weeks that documented less injury to the spinal accessory nerve. Again, these patients had improvement with time. A correlational analysis revealed that the physical parameters correlated well with the electromyographic findings, whereas each patient's perception of disability did not. These findings suggest that, in patients in whom it is oncologically sound, a neck dissection that spares the spinal accessory nerve offers significant benefit in terms of shoulder function.