Evidence of Significant Sternocleidomastoid Atrophy following Modified Radical Neck Dissection Type III

Cuccia, Giuseppe; Shelley, Odhran; d’Alcontres, Francesco Stagno; Giannitrapani, Marco; Soutar, David S.; Camilleri, I.

doi:10.1097/01.prs.0000187150.09737.1a

Cited by 6 publications

(12 citation statements)

References 15 publications

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“…16 Preservation of the spinal accessory nerve and if preserved along with sternocleidomastoid muscle, result in better shoulder function, protection of neck arteries and cosmesis. 17,18 Therefore surgeons try to preserve accessory nerve etc., when oncologially feasible. Postoperative radiation therapy is recommended for cases with large nodal metastasis and extranodal spread.…”

Section: Discussionmentioning

confidence: 99%

Efficacy/ Validity of Neck Dissection and Radiotherapy for Cervical Nodal Disease - Clinicopathological Analysis

Umar

Ahmed

Saqulain

2019

JIMDC

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Objective: To analyze treated head and neck malignancies with reference to frequency of cervical metastases and frequency of nodal recurrence following neck dissection and/ or radiotherapy for cervical metastases.Patients and Methods: This observational prospective study was conducted at ENT Department, Pakistan Institute of Medical Sciences, Islamabad over a period of 16 months. Study population was comprised of 15 cases of either gender and any age, with treated head and neck primary who developed metastatic neck disease and were included through non-probability sampling technique. Patients with primary site recurrence or distant metastases were excluded from the study. They were treated with neck dissection, radiotherapy or both for neck disease and followed up for a 1 year. Clinical data including age, gender, site and histopathology of treated primary tumor, nodal involvement both clinical and histopathological, treatment and post treatment result were recorded. Data was collected, tabulated and analyzed using Microsoft excel worksheet.Results: Out of total 15 cases, 17% patients were with N1 disease, 33% patients with N2a disease, and 50% were with N2b disease. Total 3 (20%) patients received radiotherapy (2 being unfit for surgery and 1 due to refused consent) and 12 (80%) patients underwent surgery. Out of these 12, 3 underwent RND, 7 MRND and 2 SND. Total 20% (3) developed recurrence.Conclusion: Combination of RND or MRND and radiotherapy is highly effective in controlling neck disease in controlled primary tumors.

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Section: Discussionmentioning

confidence: 99%

Efficacy/ Validity of Neck Dissection and Radiotherapy for Cervical Nodal Disease - Clinicopathological Analysis

Umar

Ahmed

Saqulain

2019

JIMDC

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“… 6 – 8 These studies demonstrated significant SCM atrophy after mRND or selective neck dissection. Cuccia et al 7 reported the frequency and the extent of SCM atrophy after mRND type III using ultrasonography. They used the absolute asymmetry index (AAI).…”

Section: Discussionmentioning

confidence: 99%

“…The percentage against the mean of bilateral SCM areas was considered to be more easily grasped than that against the sum, so AI was chosen for this study. Cuccia et al 7 declared that >10% on the AAI (same as 20% on the AI) represented severe asymmetry and found that it was observed in 98% of the caudal portion of the SCM and in 80% of the middle portion after mRND that spared the SAN. Ohtawa et al 6 similarly found atrophy in 90% of the caudal portion of the SCM.…”

Section: Discussionmentioning

confidence: 99%

“…Surprisingly, SOHND caused muscle atrophy more frequently at the cricoid cartilage level than at the hyoid bone level. Because the inferior surgical border of SOHND is the supraomohyoid muscle, blood supply to the lower third of the SCM from the subclavian branch 6 , 7 cannot be disturbed. Another blood supply to the caudal half of the SCM is a branch of the superior thyroid artery, 6 , 13 which is always encountered during SOHND.…”

Section: Discussionmentioning

confidence: 99%

“…where CSA c and CSA a are cross-sectional areas assessed at the control and affected sides, respectively. Index values >20% were defined as severe asymmetry, 7 , 11 and those >50% were defined as extremely severe asymmetry.…”

Section: Methodsmentioning

confidence: 99%

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Preventable Sternocleidomastoid Muscular Atrophy after Neck Dissection

Yamamoto

Sawai

Ishimoto

et al. 2015

Plastic and Reconstructive Surgery - Global Open

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Background:Modified radical neck dissection (mRND) [preserving the sternocleidomastoid muscle (SCM) and the spinal accessory nerve] and supraomohyoid neck dissection have become common surgical procedures for treating head and neck cancer. Postoperative severe asymmetry of the neck and severe atrophy of the SCM, however, have been demonstrated.Methods:Using computed tomographic images, cross-sectional areas of the SCMs were measured in 99 patients with carcinoma of the oral cavity who underwent unilateral mRND or supraomohyoid neck dissection. An asymmetry index was used.Results:Innervation to the SCM was preserved in 91 patients. The spinal accessory nerve and the innervation were sacrificed in 3 patients; the innervation was repaired in 5 patients. Sacrifice of innervation to the SCM resulted in extremely severe asymmetry. Repair of the innervation prevented severe asymmetry in 40%. Preservation of the innervation prevented severe asymmetry in 75% at the middle portion of the neck and in 56% at the lower portion after mRND.Conclusion:Preserving innervation to the SCM and gentle handling of the nerve during neck dissection could prevent severe asymmetry after neck dissection.

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The Evolution of and Risk Factors for Neck Muscle Atrophy and Weakness in Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy

Zhang

Mao

Zhou³

et al. 2015

Medicine

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The aim of this study was to investigate the evolution of sternocleidomastoid muscle (SCM) atrophy in nasopharyngeal carcinoma (NPC) patients following intensity-modulated radiotherapy (IMRT), and the relationship between SCM atrophy and neck weakness.Data were retrospectively analyzed from 223 biopsy-proven NPC patients with no distant metastasis who underwent IMRT with or without chemotherapy. The volume of SCM was measured on pretreatment magnetic resonance imaging (MRI), and MRIs were conducted 1, 2, and 3 years after the completion of IMRT. Change in SCM volume was calculated and classified using the late effects of normal tissues–subjective, objective, management, and analytic system. The grade of neck muscle weakness, classified by the Common Terminology Criteria for Adverse Events V 3.0, was measured 3 years after the completion of IMRT.The average SCM atrophy ratio was −10.97%, −18.65%, and −22.25% at 1, 2, and 3 years postirradiation, respectively. Multivariate analysis indicated N stage and the length of time after IMRT were independent prognostic variables. There were significant associations between the degree of SCM atrophy and neck weakness.Radical IMRT can cause significant SCM atrophy in NPC patients. A more advanced N stage was associated with more severe SCM atrophy, but no difference was observed between N2 and N3. SCM atrophy progresses over time during the 3 years following IMRT. Grade of SCM atrophy is significantly associated with neck weakness.

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Evidence of Significant Sternocleidomastoid Atrophy following Modified Radical Neck Dissection Type III

Abstract: Despite evidence of significant atrophy, the muscle still underwent morphological changes during contraction that were comparable to those on the normal control side.

Cited by 6 publications

References 15 publications

Efficacy/ Validity of Neck Dissection and Radiotherapy for Cervical Nodal Disease - Clinicopathological Analysis

Efficacy/ Validity of Neck Dissection and Radiotherapy for Cervical Nodal Disease - Clinicopathological Analysis

Preventable Sternocleidomastoid Muscular Atrophy after Neck Dissection

The Evolution of and Risk Factors for Neck Muscle Atrophy and Weakness in Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy

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