Assessment of shoulder function after functional neck dissection and selective neck dissection (Levels I, II, III) in patients with carcinoma of tongue: a comparative study

Abstract

Background and objectivesTo compare shoulder function with respect to pain and disability in patients who have undergone nerve sparing neck dissection i.e. selective neck dissection (levels I, II, III) and functional neck dissection as a part of their treatment modality for carcinoma tongue on a follow up of minimum six months. Material and methods A total of 100 patients were selected for this study. 50 patients who had undergone selective neck dissection (levels I, II, III) and 50 who underwent functional neck dissection as a part of their treatment modality for squamous cell carcinoma of the tongue from January 2005 to January 2007 were asked to participate in this study. A standardized questionnaire was used to assess pain and disability. Pain and disability scores were then compared between the two nerve sparing dissections. Results 100% of the patients in Selective Neck Dissection (SND) (levels I, II, III) group and in Functional Neck Dissection (FND) groups complained of pain. Though there is pain present in both the treatment groups, no significant difference in the pain values was found between FND and SND (levels I, II, III) in any of the pain parameters. Disability was present in both the treatment groups. However patients who have undergone FND had significantly higher severity of disability when compared to SND (levels I, II, III) especially during activities which involve shoulder abduction like dressing, doing heavy household work, hair wash and washing clothes/dishes (5.18, 5.22, 5.5, 4.88 in FND and 2.26, 4.08, 4.58, 2.2 in SND (levels I, II, III) respectively. Disability perceived during other activities like doing heavy household and facial care was 2.08 and 1.84 in both the treatment groups respectively. Interpretation and Conclusion Degree of shoulder morbidity is much higher in patients who have undergone FND as compared to SND (levels I, II, III) as a treatment modality for carcinoma tongue, even though both the treatment options are nerve preserving.

Oncologic outcomes of selective neck dissection in HPV‐related oropharyngeal squamous cell carcinoma

“…Patients with this disease often have advanced clinical neck metastasis at initial presentation, and deescalation of treatment without compromise of oncologic outcomes is the concept behind current HPV‐OPSCC–related research . In this report, complications of the neck dissection were low and prior authors have shown that both perioperative and long‐term complications, particularly related to shoulder morbidity, are significantly lower for SND than MRND.…”

Oncological Outcome of Node‐Positive Oral Squamous Cell Carcinomas Treated With Selective and Comprehensive Neck Dissection

“…However, the extent of ND, as well as any adjuvant/nonsurgical treatment regimen, can influence health-related quality of life [ 11 – 14 ]. Shoulder dysfunction including scapula flaring, shoulder drop, and limited arm abduction attributed to spinal accessory nerve impairment, phrenic nerve injury, and chylous leakage, has been associated with the extent of ND [ 15 – 18 ]. Therefore, a less extensive surgical treatment regime while maintaining oncologic control would be preferable.…”