scholarly journals Electromyographic Assessment of Accessory Nerve Function Following Nerve Sparing Neck Dissection

2013 ◽  
Vol 4 (1) ◽  
pp. 19-23
Author(s):  
Sagaya Raj ◽  
Shuaib Merchant ◽  
Azeem Mohiyuddin ◽  
Oomen LNU ◽  
Philip John Kottaram
Keyword(s):  
Head And Neck ◽  
Neck Dissection ◽  
Radical Neck Dissection ◽  
Shoulder Function ◽  
Head And Neck Cancers ◽  
Accessory Nerve ◽  
Nerve Sparing ◽  
Nerve Function ◽  
Shoulder Dysfunction ◽  
Upper Trapezius

ABSTRACT Aims To assess preoperative and postoperative shoulder function by electromyography (EMG) in spinal accessory nerve (SAN) sparing neck dissections in head and neck cancers. Materials and methods A prospective study was done on 50 patients (51 shoulders) with histopathologically proven head and neck cancers with N0 or N1 neck who underwent nerve sparing neck dissections. Patients were assessed preoperatively and postoperatively at 3 weeks and 3 months by needle EMG and muscle strength tests of upper trapezius. Results and interpretation: At 3 weeks postoperatively, 11 shoulders (39.3%) in FND group and four shoulders (33.3%) in modified radical neck dissection (MRND) group showed severely abnormal EMG, while in supraomohyoid neck dissection (SOHND) group only two (18.2%) shoulders showed severely abnormal EMG. All patients who underwent nerve sparing neck dissections showed improvement in at least one category on the second electromyogram at 3 months. This could be attributed to neuropraxia or transient devascularization of the accessory nerve. In our study, 11 patients in FND group showed severely abnormal EMG finding, but they did not have as great a degree of shoulder dysfunction as would be expected. This could be due to factors like preoperative condition of other synergistic shoulder girdle muscles, postoperative exercises, etc. Conclusion SAN injuries are common in all types of nerve sparing neck dissections requiring aggressive physiotherapy for an improved shoulder function. To conclude, in patients in whom it is oncologically sound, nerve sparing neck dissections offers significant benefit in terms of shoulder function. How to cite this article Mohiyuddin A, Raj S, Merchant S, Oomen, Kottaram PJ. Electromyographic Assessment of Accessory Nerve Function Following Nerve Sparing Neck Dissection. Int J Head and Neck Surg 2013;4(1):19-23.

Spinal accessory nerve function after neck dissections

2006 ◽  
Vol 121 (1) ◽  
pp. 44-48 ◽  
Author(s):  
K S Orhan ◽  
T Demirel ◽  
B Baslo ◽  
E K Orhan ◽  
E A Yücel ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Radical Neck Dissection ◽  
Shoulder Function ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Nerve Function ◽  
Double Blind ◽  
Spinal Accessory ◽  
The Third ◽  
Object Lifting

The aim of this study was to evaluate spinal accessory nerve function after functional neck dissection (FND) and radical neck dissection (RND) by monitoring the nerve with electromyographic (EMG) examinations. A prospective, double-blind, clinical study was undertaken in 21 patients (42 neck side dissections) operated on for head and neck malignant diseases, separated into two groups: 10 neck sides in the RND group and 32 neck sides in the FND group. Electromyographic examinations were performed pre-operatively and post-operatively in the third week and third and ninth months. Additionally, a questionnaire, modified from the neck dissection impairment index, was applied to all the patients in order to assess shoulder function in the ninth post-operative month.All patients had maximum EMG scores pre-operatively. Following the operation, motor amplitudes decreased in both groups. At the third post-operative month, amplitudes decreased to their lowest values. As expected, the decreases in amplitude and EMG score were more prominent in the RND group. Following reinnervation, the amplitudes of the trapezius motor response increased in the FND group but never reached pre-operative values (during the time of follow up). The FND group scores for pain, neck and shoulder stiffness, and disability in heavy object lifting, light object lifting and reaching overhead were significantly lower than those of the RND group.In FND, one aims to preserve anatomically the spinal accessory nerve, and it is presumed to be intact after the procedure. However, using EMG nerve function monitoring, our study revealed that profound spinal nerve injury was detected immediately after FND surgery, which tended to improve over subsequent months but had not regained its original function by the end of the ninth post-operative month.

Accessory nerve: anatomy and surgical identification

2007 ◽  
Vol 121 (12) ◽  
pp. 1118-1125 ◽  
Author(s):  
S Lloyd
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Neck Dissection ◽  
Cranial Nerve ◽  
Radical Neck Dissection ◽  
Neck Surgery ◽  
Accessory Nerve ◽  
Nerve Sparing ◽  
Selective Neck Dissection ◽  
Shoulder Syndrome

AbstractThe XIth cranial nerve or accessory nerve provides the motor supply to the sternocleidomastoid and trapezius muscles. It is frequently encountered during neck surgery, and as such is at risk of iatrogenic injury, resulting in the ‘shoulder syndrome’. Historically, the nerve was sacrificed on oncological grounds during radical neck dissection. However, the basis for sacrifice is unfounded in the majority of cases, and accessory nerve sparing selective neck dissection has equal oncological efficacy. The path of the nerve in the neck is very variable, and there is not a wholly reliable landmark for its identification. However, there are a number of methods described in the literature to guide the surgeon in its identification. This paper provides a systematic review of all the methods available for identification of the accessory nerve, and comments on the reliability of each. In doing so, the detailed anatomy of the accessory nerve is also described.

Spinal Accessory Nerve Function following Neck Dissection

1988 ◽  
Vol 97 (1) ◽  
pp. 83-86 ◽  
Author(s):  
Francesco Zibordi ◽  
Federico Baiocco ◽  
Cristina Bascelli ◽  
Artilio Bini ◽  
Alfredo Canepa
Keyword(s):  
Neck Dissection ◽  
Radical Neck Dissection ◽  
Trapezius Muscle ◽  
Neck Surgery ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Nerve Function ◽  
Spinal Accessory ◽  
Muscle Testing

Spinal accessory nerve (SAN) function was evaluated by electromyography (EMG) and muscle testing in 36 patients who underwent neck dissection with SAN preservation. The results emphasized that SAN function was relatively good after conservative neck surgery. Muscle testing findings showed better function than did EMC findings. After surgery the trapezius muscle functioned more efficiently than the sternocleidomastoid (SCM) muscle probably because of the more traumatic surgical handling of both the SCM muscle and its SAN branch. In order to obtain the functional advantages of SAN preservation, the authors suggest that the conservative procedure in radical neck dissection be used whenever warranted by oncologic diagnosis.

An audit into the incidence of handicap after unilateral radical neck dissection

1991 ◽  
Vol 105 (9) ◽  
pp. 760-762 ◽  
Author(s):  
G. R. Shone ◽  
M. P. J. Yardley
Keyword(s):  
Neck Dissection ◽  
Severe Pain ◽  
Radical Neck Dissection ◽  
Accessory Nerve ◽  
Nerve Function

AbstractForty-six patients who had undergone a radical neck dissection more than six months previously were assessed to determine the degree of handicap that results from division of the accessory nerve. Employment problems, amount of pain, and social and recreational difficulties were assessed. Forty-six per cent of those in employment prior to their operation gave up their work specifically because of problems with their shoulder; this affected more manual than non-manual workers (11 out of 20 manual compared with zero out of four non-manual). Thirty per cent complained of moderately severe or severe pain related to the shoulder. The amount of pain could not be correlated with age, sex, side of operation in relation to handedness, physical build of the patient, or whether the patient had been treated with radiotherapy. Although this is the largest study to address this question since that of Ewing and Martin in 1952, the small numbers involved mean that if any such correlation exists then it may not have become apparent. In view of this incidence of pain and occupational handicap, we feel that efforts should be made to preserve accessory nerve function in cases where surgical clearance of the tumour field is not compromised as a result.

Organ sparing neck dissection for the treatment of head and neck cancers in children

2017 ◽  
Vol 16 (4) ◽  
pp. 56-61
Author(s):  
N.S. Grachev ◽  
◽  
I.N. Vorozhtsov ◽  
N.V. Babaskina ◽  
E.Yu. Iaremenko ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Dissection ◽  
Head And Neck Cancers ◽  
Organ Sparing
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