Objective comparison of physical dysfunction after neck dissection

Sobol, Steven E.; Jensen, Christine C.; Sawyer, W. A.; Costiloe, Paul; Thong, Nguyen

doi:10.1016/0002-9610(85)90164-3

Cited by 139 publications

(125 citation statements)

References 13 publications

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“…This approach is associated with significant morbidity, including neck fibrosis, pain, and shoulder dysfunction secondary to spinal accessory nerve injury. [9][10][11] Studies have shown that limiting the extent of neck dissection results in decreased morbidity. [12][13][14][15][16][17] The hypothetical problem with a less extensive neck dissection is the risk of leaving behind regional disease.…”

Section: Conclusion Rcr On Post-rtmentioning

confidence: 99%

Lymph node‐positive head and neck cancer treated with definitive radiotherapy

Yeung

Liauw

Amdur

et al. 2008

Cancer

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We investigated the prognostic impact of absolute lymphocyte count (ALC) following induction chemotherapy in newly diagnosed adult acute lymphoblastic leukemia (ALL). Patients with ALC ≥350 cells/μL at day 28 had a median overall survival (OS) of 47.4 months when compared with 17.6 months for those with an ALC <350 cells/μL (HR = 1.98, P = 0.007). Among patients who achieved a complete remission, median event‐free survival (EFS) for those with ALC ≥350 cells/μL on day 28 was 42.1 months when compared with 13.9 months in those with ALC <350 cells/μL (HR = 2.08, P = 0.006). In multivariable analysis, the ALC on day 28 (<350 cells/μL vs. ≥350 cells/μL, P ≤ .0004 for OS and EFS) along with WBC at diagnosis (≤6.0 or >30.0 K/μL vs. >6.0–30.0 K/μL, P ≤ 0.002 for OS and EFS) and cytogenetics (abnormal vs. normal, P = 0.002 for OS and P = 0.02 for EFS) were independent prognostic factors of both OS and EFS. Combining these three factors segregates patients in three well‐defined risk groups. These data suggest that ALC can be used in combination with other prognostic features to better predict outcome and that targeting the immune system to improve ALC may be a worthwhile strategy in ALL. Am. J.Hematol. © 2012 Wiley Periodicals, Inc.

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Section: Conclusion Rcr On Post-rtmentioning

confidence: 99%

Lymph node‐positive head and neck cancer treated with definitive radiotherapy

Yeung

Liauw

Amdur

et al. 2008

Cancer

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“…7,13,14,22,46,53 Diagnosis of SANP is typically achieved by identifying associated signs such as trapezius atrophy, depressed shoulder girdle, scapular dyskinesis, trapezius weakness, and limited shoulder active abduction. 6,9,11,[13][14][15]28,29,31,46,48,49,53,52 Unfortunately, many of these signs are observational and unreliably recognized, which may explain a high rate of misdiagnosis. 3,4 Assessing scapular dyskinesis is unreliable.…”

Section: Case Series Descriptionmentioning

confidence: 99%

“…The SCM and trapezius (upper, middle, and lower) muscles were tested us- 14,29,49 up to at least 3 months following surgery. Preservation of the cervical plexus has not been found to decrease symptoms or improve function.…”

Section: Examinationmentioning

confidence: 99%

“…40 Spinal accessory nerve injury commonly occurs during neck dissection surgery. 2,6,9,11,[13][14][15][27][28][29]31,43,46,48,49,52,53 Neck dissection surgery is performed to treat head and neck carcinoma and is categorized into 3 different procedures: radical S pinal accessory nerve palsy (SANP) is common following neck dissection surgery or lymph node excision, 2,6,9,11,[13][14][15][27][28][29]31,43,46,48,49,52,53 blunt or penetrating trauma to the lateral neck region, 2,11 and cervical stretch injuries. 32 Spinal accessory nerve injury results in trapezius paralysis or dysfunction and a diagnostic cluster of signs and symptoms, including shoulder girdle depression, trapezius atrophy, scapular dyskinesis, loss of shoulder STUDY DESIGN: Retrospective case series.…”

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confidence: 99%

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Spinal Accessory Nerve Palsy: Associated Signs and Symptoms

Kelley¹

2008

J Orthop Sports Phys Ther

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signs and symptoms were found related to SANP. A strong relationship appeared between the presence of the scapular flip sign and SANP. The suspected mechanism for the scapular flip sign is the unopposed pull of the humeral external rotators by the inactive middle and lower trapezius. Early identification of SANP can assist with the prognosis, explain persistent impairments and functional deficits, motivate appropriate diagnostic testing and interventions, and help maximize outcome. Further research to validate the scapular flip sign and establish a clinical prediction rule for the diagnosis of SANP should be performed.

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“…[2][3][4] However, even with accessory nerve-sparing neck dissections, shoulder dysfunction can be seen. [5][6][7][8] Shoulder syndrome is thought to be multifactorial and can be due to devascularization of the accessory nerve and/or cervical plexus, Wallerian degeneration, and/or variable innervation of the trapezius.…”

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confidence: 99%

Association Between Multimodality Neck Treatment and Work and Leisure Impairment

Gallagher

Sacco

Lee

et al. 2015

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEThis study describes the effect of adjuvant treatment on shoulder-related quality of life, leisure activities, and employment for patients undergoing neck dissection for head and neck cancer.OBJECTIVE To explore the association between treatment outcome and shoulder-related on critical daily life functions such as employment and recreation. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of patients with head and neck cancer at a tertiary care hospital.EXPOSURES Level V-sparing selective neck dissection or modified radical neck dissection sparing the accessory nerve, with or without radiation therapy and/or chemotherapy. MAIN OUTCOMES AND MEASURESPatients completed the Neck Dissection Impairment Index (NDII), with scores ranging from 0 to 100 and higher scores indicating better shoulder functioning and shoulder-related quality of life, and underwent objective testing with the Constant-Murley Shoulder Function Test (Constant test) at least 12 months after the completion of all adjuvant treatment. Additional outcome measures related to physical therapy, pain medication use, leisure activity, and employment status. CONCLUSIONS AND RELEVANCE More aggressive treatment, either in the form of increased surgical dissection, radiation therapy, or chemotherapy, was associated with worse shoulder function and quality of life. The degree of impairment perceived by the patient and measured in objective testing was correlated with leisure activity and employment status. These findings may stimulate further investigation related to optimizing quality of life following neck dissection.

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Objective comparison of physical dysfunction after neck dissection

Cited by 139 publications

References 13 publications

Lymph node‐positive head and neck cancer treated with definitive radiotherapy

Lymph node‐positive head and neck cancer treated with definitive radiotherapy

Spinal Accessory Nerve Palsy: Associated Signs and Symptoms

Association Between Multimodality Neck Treatment and Work and Leisure Impairment

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