Objective Comparison of Shoulder Dysfunction after Three Neck Dissection Techniques

Abstract

A prospective study with subjective evaluation of shoulder pain and objective evaluation of shoulder muscle strength by isokinetic testing and electromyographic and electroneurographic studies of spinal accessory nerve function was performed on patients who had undergone neck dissection procedures. Twenty-one patients with head and neck cancer were enrolled in this study. Three types of neck dissection were performed: 7 selective neck dissections, 9 modified radical neck dissections, and 5 radical neck dissections. All patients who underwent radical neck dissection had shoulder pain, and 80% of them had shoulder droop after the operation. In the patients who underwent selective neck dissection, the electromyographic findings of the spinal accessory nerve were relatively normal. Their shoulder strength was sometimes decreased at I month after operation, but it had returned to preoperative strength by the 6-month follow-up visit. These findings suggested that patients who underwent selective neck dissection had the least damage to spinal accessory nerve function and the least shoulder disability after neck dissection.

Is Level IIb Lymph Node Dissection Always Necessary in N1b Papillary Thyroid Carcinoma Patients?

“…The complication rate increases as the cervical LND range becomes more radical [13,14,27]. Some reports show that more extensive neck surgery is associated with greater postoperative shoulder dysfunction [28,29].…”

Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: A systematic review

“…Abnormal trapezius muscle electromyography findings were present in all patients following RND (100%) [26] compared with 27 to 78% following MRND [26,27] and 0 to 85% following SND [25][26][27]. Preserving the cervical root branches had an effect on the incidence of shoulder pain: 14% of patients who underwent ND with preservation of the cervical root branches had shoulder pain compared with 69% of patients in whom the branches had been resected [28].…”

“…RND: 13% (timeframe not listed) [54]; 60% at 6 months postsurgery; 100% at 6 months post-surgery [26]. MRND: 31% at 6 months post-surgery [56]; 40% (timeframe not listed) [54]; 56% at 6 months post-surgery [26]. RND/MRND with CP sacrificed: 13% at 2 weeks post-surgery; 31% at 6 months post-surgery [70].…”

“…For example, several studies did not specify whether their measurement of shoulder range of motion was active or passive [17,26,37,53,54]. Shoulder droop was observed as a dichotomous variable (present/not present) [4,5,20,21,23,25,55,56], but only one study employed an objective, quantitative procedure of this measure [57].…”

Preservation of Spinal Accessory Nerve during Radical Neck Dissection

“…However reports continue to be published stating the favourable outcome of SAN preservation [8,9,10] . Our cases have been operated upon and followed up by a single surgeon, under service conditions, using standard techniques and the results support the usefulness of this technique.…”