Accessory nerve lesion after cervicofacial lift: Clinical and electrodiagnostic evaluations of two cases

Abstract

Two cases of accessory nerve lesion are reported that occurred within 2.5 weeks and 4.5 weeks, respectively, after surgery for cervicofacial lift. The patients were referred for electrodiagnostic examination because of persistent and unexplained unilateral shoulder pain and disability, 6 and 5 months, respectively, after face lift. In both cases clinical examination revealed severe right-shoulder weakness related to trapezius palsy, without trapezius muscle atrophy in the first case and with trapezius atrophy in the second. Electrodiagnosis revealed bilateral accessory nerve lesions in the first case and a unilateral lesion in the second case. Recovery for both cases was progressive but delayed, and both were evaluated 11 and 10 months, respectively, after the first evaluation. Clinical and especially electrodiagnostic findings suggested that the accessory nerve lesion was related to conduction block in the first case and severe axonal loss in the second case.

Diagnosis of unilateral trapezius muscle palsy: 54 Cases

“…The DML of the upper and lower TM was slightly greater than normal and differed mildly between medical and surgical cases, as is usual in axonal lesions (Table ). In 2 exceptional cases of cervicofacial lift with chronic SAN compression, the DML was obviously increased . The surgical and medical cases differed mainly in CMAP amplitude in the upper TM (−93% vs −67%, respectively).…”

“…Most patients had a dropped shoulder at rest, and many elevated the impaired shoulder when they attempted to abduct the abnormal upper limb (Fig. A) . In all patients in whom full elevation of the upper limb was possible, dynamic examination of the posterior view of the scapula demonstrated abrupt sliding of the scapula laterally and downward during lateral elevation of the arm, with a very short latency: 0.24 to 0.52 s (Fig.…”

“…Nineteen cases with unilateral TM palsy occurred after a surgical procedure: cervical lymph node biopsy ( n = 8); cancer of the tongue ( n = 2); laryngeal cancer ( n = 1); parotid gland cancer ( n = 1); cervical lipoma ( n = 1); carotid and vertebral bypass ( n = 1); selective neck dissection ( n = 2); cervicofacial lift ( n = 2); and traumatic neck wound ( n = 1). The clinical diagnosis proposed by the referring physician was SAN lesion in 11 patients (58%), cervical root disorder in 4 patients, suprascapular nerve lesion in 2 patients, and rotator cuff lesion in 3 patients; with >1 possibility per patient in some patients.…”

“…With the patient at rest, a frequent observation was the rope‐like major rhomboid muscle between the medial margin of the scapula and the spine (Fig. ) . Sometimes the winging appeared only during push‐ups or during resisted active external rotation of the shoulder (Fig.…”

Spinal Accessory Neuropathy following Dual Tunneling of Lead Extensions for Motor Cortex Stimulation

“…SAN injury has been associated with a number of open surgical procedures requiring direct manipulation within the posterior cervical triangle. Postsurgical SAN injury is commonly seen after lymph node biopsy [1], but may also occur following carotid endarterectomy [6], internal jugular cannulation [7], cervicofacial lift [8] and ventriculoatrial shunt placement [9]. We report a case with a new mechanism of spinal accessory neuropathy: that of the entrapment of the nerve between extension leads for motor cortex stimulation following blind dual tunneling.…”