scholarly journals SPINAL ACCESSORY NERVE: ANATOMICAL VARIATIONS AND ITS SIGNIFICANCE DURING NECK DISSECTION IN HEAD AND NECK CANCER

2020 ◽  
Vol 8 (3) ◽  
pp. 1150-1154
Author(s):  
Aviral Verma ◽  
◽  
Mohini Narang
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Dissection ◽  
Neck Cancer ◽  
Anatomical Variations ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory

Anatomy of the Spinal Accessory Nerve Plexus: Relevance to Head and Neck Cancer and Atherosclerosis1

2002 ◽  
Vol 227 (8) ◽  
pp. 570-578 ◽  
Author(s):  
Henry Brown
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Blood Supply ◽  
Neck Cancer ◽  
Vascular Anatomy ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Nerve Plexus ◽  
Past Century ◽  
Spinal Accessory

The term spinal accessory nerve plexus may be defined as the spinal accessory nerve with all its intra- and extracranial connections to other nerves, principally cranial, cervical, and sympathetic. The term is not new. This review examines its applied anatomy in head and neck cancer and atherosclerosis. Over the centuries, general studies of neural and vascular anatomy and embryology formed a basis for the understanding upon which the plexus is described. During the past century, its anatomy and blood supply have come to be better understood. The importance of almost all of the plexus to head, neck, and upper extremity motor and sensory functions has come to be realized. Because of this understanding, surgical neck dissection has become progressively more conservative. This historical progression is traced. Even the most recent anatomic studies of the spinal accessory nerve plexus reveal configurations, new to many of us. They were probably known to classical anatomists, and not recorded in readily available literature, or not recorded at all. Human and comparative anatomic studies indicate that the composition of this plexus and its blood supply vary widely, even though within the same species their overall function is very nearly the same. Loss of any of these structures, then, may have very different consequences in different individuals. As a corollary to this statement, data are presented that the spinal accessory nerve itself need not be cut during surgical neck dissections for severe impairment to occur. In addition, data are presented supporting the theory that atherosclerosis by obstructing vessels to this plexus and its closely connected brachial plexus will very likely result in their ischemic dysfunction, often painful. Finally evidence, as well as theory, is stated concerning anatomic issues, methodology, outcome, and possible improvements in surgical procedures emphasizing conservatism.

scholarly journals Quality of Life, Shoulder Range of Motion, and Spinal Accessory Nerve Status in 5-Year Survivors of Head and Neck Cancer

PM&R ◽  
2014 ◽  
Vol 6 (12) ◽  
pp. 1073-1080 ◽  
Author(s):  
Sarah M. Eickmeyer ◽  
Christine K. Walczak ◽  
Katherine B. Myers ◽  
D. Richard Lindstrom ◽  
Peter Layde ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Range Of Motion ◽  
Head And Neck ◽  
Neck Cancer ◽  
Spinal Accessory Nerve ◽  
Spinal Accessory ◽  
Shoulder Range Of Motion ◽  
Shoulder Range

scholarly journals Spinal Accessory Nerve Duplication – A Rare Anatomical Consternation During Neck Dissectio

2021 ◽  
Vol 6 (4) ◽  
pp. 539-541
Author(s):  
Rohit Jindal ◽  
Kamal Kishor Lakhera ◽  
Pinakin Patel ◽  
Suresh Singh ◽  
Ravinder Singh Gothwal ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Anatomical Variations ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Clinical Implications ◽  
Spinal Accessory ◽  
Comprehensive Knowledge ◽  
Anatomical Knowledge ◽  
Shoulder Syndrome ◽  
Functional Neck Dissection

Prevention of the spinal accessory nerve (SAN) is an indispensable aspect of the functional neck dissection surgery to avoid highly disabling shoulder syndrome postoperatively. This requires comprehensive knowledge of the anatomy of SAN and its variations. Rare anatomical variations like SAN duplication can result in an inadvertant injury to the SAN. We report a case of duplication of SAN, which was encountered while doing a functional neck dissection surgery for oral squamous cell carcinoma. No iatrogenic injury occurred during the surgery and neither there was any SAN dysfunction post-operatively. Meticulous dissection and consistent identification of SAN, along with vast anatomical knowledge is the key to the preservation of the nerve during the surgery. This report aims to broaden our anatomical knowledge of SAN and also discuss the clinical implications and literature pertaining to the duplication of SAN.

Dual spinal accessory nerve: caution during neck dissection

2020 ◽  
Vol 13 (6) ◽  
pp. e235487
Author(s):  
Muhammad Hassan Danish ◽  
Haissan Iftikhar ◽  
Mubasher Ikram
Keyword(s):  
Neck Dissection ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Selective Neck Dissection ◽  
Shoulder Dysfunction ◽  
Spinal Accessory ◽  
Functional Morbidity

Preserving the spinal accessory nerve (SAN) is an important step in the modern-day neck dissection to avoid postoperative functional morbidity in patients. This goal can become technically difficult, especially, when rare anatomical variations are encountered. We present a case of dual SAN in a patient undergoing selective neck dissection for oral squamous cell carcinoma. Both SANs were preserved and patient had no shoulder dysfunction postoperatively. We take this opportunity to emphasise that meticulous dissection is the only proven way to preserve the nerve. And that surgeons should be aware of this anatomical variation. SAN should be subjected to minimal traction during neck dissection to avoid tension neuropraxia and long-term shoulder dysfunction.

scholarly journals Swedish National Multicenter Study on Head and Neck Cancer of Unknown Primary: Prognostic Factors and Impact of Treatment on Survival

2020 ◽  
Author(s):  
Lars Axelsson ◽  
Erik Holmberg ◽  
Jan Nyman ◽  
Anders Högmo ◽  
Helena Sjödin ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Prognostic Factors ◽  
Head And Neck ◽  
Neck Dissection ◽  
Neck Cancer ◽  
Multicenter Study ◽  
Performance Status ◽  
Cancer Of Unknown Primary ◽  
Unknown Primary ◽  
N Stage

Abstract Introduction Head and neck cancer of unknown primary (HNCUP) is a rare condition whose prognostic factors that are significant for survival vary between studies. No randomized treatment study has been performed thus far, and the optimal treatment is not established. Objective The present study aimed to explore various prognostic factors and compare the two main treatments for HNCUP: neck dissection and (chemo) radiation vs primary (chemo) radiation. Methods A national multicenter study was performed with data from the Swedish Head and Neck Cancer Register (SweHNCR) and from the patients' medical records from 2008 to 2012. Results Two-hundred and sixty HNCUP patients were included. The tumors were HPV-positive in 80%. The overall 5-year survival rate of patients treated with curative intent was 71%. Age (p < 0.001), performance status (p= 0.036), and N stage (p= 0.046) were significant factors for overall survival according to the multivariable analysis. Treatment with neck dissection and (chemo) radiation (122 patients) gave an overall 5-year survival of 73%, and treatment with primary (chemo) radiation (87 patients) gave an overall 5-year survival of 71%, with no significant difference in overall or disease-free survival between the 2 groups. Conclusions Age, performance status, and N stage were significant prognostic factors. Treatment with neck dissection and (chemo) radiation and primary (chemo) radiation gave similar survival outcomes. A randomized treatment study that includes quality of life is needed to establish the optimal treatment.

scholarly journals Effectiveness of nivolumab affected by prior cetuximab use and neck dissection in Japanese patients with recurrent or metastatic head and neck cancer: results from a retrospective observational study in a real-world setting

2021 ◽  
Author(s):  
Shin Kariya ◽  
Yasushi Shimizu ◽  
Nobuhiro Hanai ◽  
Ryuji Yasumatsu ◽  
Tomoya Yokota ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Dissection ◽  
Neck Cancer ◽  
Median Overall Survival ◽  
Response Rate ◽  
Objective Response ◽  
Progression Free Survival ◽  
Japanese Patients ◽  
Free Survival

Abstract Background To examine the effect of prior use of cetuximab and neck dissection on the effectiveness of nivolumab, we conducted a large-scale subgroup analysis in Japanese patients with recurrent/metastatic head and neck cancer. Methods Data on the effectiveness of nivolumab were extracted from patient medical records. All patients were analyzed for effectiveness by prior cetuximab use. In the analyses for prior neck dissection, only patients with locally advanced disease were included. Results Of 256 patients analyzed, 155 had received prior cetuximab. Nineteen of 50 patients with local recurrence underwent neck dissection. The objective response rate was 14.7 vs 17.2% (p = 0.6116), median progression-free survival was 2.0 vs 3.1 months (p = 0.0261), and median overall survival was 8.4 vs 12 months (p = 0.0548) with vs without prior cetuximab use, respectively. The objective response rate was 23.1 vs 25.9% (p = 0.8455), median progression-free survival was 1.8 vs 3.0 months (p = 0.6650), and median overall survival was 9.1 vs 9.9 months (p = 0.5289) with vs without neck dissection, respectively. Conclusions These findings support the use of nivolumab for patients with recurrent/metastatic head and neck cancer regardless of prior cetuximab use or neck dissection history. Trial registration number UMIN-CTR (UMIN000032600), Clinicaltrials.gov (NCT03569436)

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