Özgür TARKAN, Özgür SÜRMELİOĞLU, Süleyman ÖZDEMİR, Hacer BOZDEMİR, Tunay SARPEL, Ülkü TUNCER

Clinical and electrophysiological evaluation of shoulder functions in spinal accessory nerve-preserving neck dissection

The aim of this study was to evaluate shoulder functions after neck dissection with preservation of the spinal accessory nerve by objective physical examination, electromyographic findings, and subjective patient complaints, and also to investigate the effect of the type of neck dissection. Materials and methods: The present study included 29 patients on whom unilateral selective or modified radical neck dissection was performed for head and neck cancer and/or metastasis to the neck. Electromyographical findings, range of motion, and pain scores of the shoulder joint were determined for the operated and nonoperated (control) sides. Results: An electromyographic examination of the trapezius and sternocleidomastoid muscle with superficial and pin electrodes showed a statistically significant difference when comparing the latency and amplitude values of the operated and nonoperated sides (P < 0.05). Flexion, abduction, and external rotation of the shoulder joint were found to be significantly affected on the operated side (P < 0.05). Electrophysiological differences were not found with regards to neck dissection types. Mild or moderate pain was observed at the early stage with a visual pain scale. Conclusion: Despite spinal accessory nerve preservation during neck dissection, electrophysiological changes and alterations in clinical functions might be seen in all areas of the nerve that innerves the shoulder muscles.

Anahtar Kelimeler:

Key words: Selective neck dissection, shoulder dysfunction, spinal accessory nerve, head and neck cancer, range of motion, rehabilitation

Clinical and electrophysiological evaluation of shoulder functions in spinal accessory nerve-preserving neck dissection

Keywords:

Key words: Selective neck dissection, shoulder dysfunction, spinal accessory nerve, head and neck cancer, range of motion, rehabilitation,

PDF

___

Robbins KT, Shaha AR, Medina JE, Califano JA, Wolf GT, Ferlito A et al. Consensus statement on the classifi cation and terminology of neck dissection. Arch Otolaryngol Head Neck Surg 2008; 134: 536-8.
Krause HR. Shoulder-arm-syndrome aft er radical neck dissection: its relation with the innervation of the trapezius muscle. Int J Oral Maxillofac Surg 1992; 21: 276-9. 9. Leipzeg B, Suen JY, English JL, Barnes J, Hooper M. Functional evaluation of the spinal accessory nerve aft er neck dissection. Am J Surg 1983; 146: 526-30.
Wietz JW, Wietz SL, McElhinney AJ. A technique for preservation of spinal accessory nerve function in radical neck dissection. Head Neck Surg 1982; 5: 75-8.
Zibordi F, Baiocco F, Bascelli C, Bini A, Canepa A. Spinal accessory nerve function following neck dissection. Ann Otol Rhinol Laryngol 1988; 97: 83-6.
Köybasioglu A, Tokcaer AB, Uslu SS, Ileri F, Beder L, Ozbilen S. Accessory nerve function aft er modifi ed radical and lateral neck dissections. Laryngoscope 2000; 110: 73-7.
Cheng PT, Hao SP, Lin YH, Yeh AR. Objective comparison of shoulder dysfunction aft er three neck dissection techniques. Ann Otol Rhinol Laryngol 2000; 109: 761-6.
Erisen L, Basel B, Irdesel J, Zarifoglu M, Coskun H, Basut O et al. Shoulder function aft er accessory nerve-sparing neck dissections. Head Neck 2004; 26: 967-71.
Orhan KS, Demirel T, Baslo B, Orhan EK, Yücel EA, Güldiken Y et al. Spinal accessory nerve function aft er neck dissections. J Laryngol Otol 2007; 121: 44-8.
Cappiello J, Piazza C, Giudice M, De Maria G, Nicolai P. Shoulder disability aft er diff erent selective neck dissections (levels II-IV versus levels II-V): a comparative study. Laryngoscope 2005; 115: 259-63.
Sobol S, Jensen C, Sawyer W. Objective comparison of physical dysfunction aft er neck dissection. Am J Surg 1985; 150: 503-9.
Ferlito A, Silver CE, Rinaldo A. Elective management of the neck in oral cavity squamous carcinoma: current concepts supported by prospective studies. Br J Oral Maxillofac Surg 2009; 47: 5-9.
Köybaşıoğlu A, Bora Tokçaer A, Inal E, Uslu S, Koçak T, Ural A. Accessory nerve function in lateral selective neck dissection with undissected level IIb. ORL J Otorhinolaryngol Relat Spec 2006; 68: 88-92.
Sezen OS, Kubilay U, Haytoglu S, Unver S. Frequency of metastases at the area of the supraretrospinal (level IIB) lymph node in laryngeal cancer. Head Neck 2007; 29: 1111-4.
Celik B, Coskun H, Kumas FF, Irdesel J, Zarifoglu M, Erisen L et al. Accessory nerve function aft er level 2B-preserving selective neck dissection. Head Neck 2009; 31: 1496-501.
Silverman DA, El-Hajj M, Strome S, Esclamado RM. Prevalence of nodal metastases in the submuscular recess (level IIb) during selective neck dissection. Arch Otolaryngol Head Neck Surg 2003; 129: 724-8.
Teymoortash A, Hoch S, Eivazi B, Werner JA. Postoperative morbidity aft er diff erent types of selective neck dissection. Laryngoscope 2010; 120: 924-9.
Brown H, Burns S, Kaiser CW. Th e spinal accessory nerve plexus, the trapezius muscle and shoulder stabilization aft er radical neck cancer surgery. Ann Surg 1988; 208: 654-61.
Saunders WH, Johnson EW. Rehabilitation of the shoulder aft er radical neck dissection. Ann Otol Rhinol 1975; 84: 812-6.
Dilber M, Kasapoglu F, Erisen L, Basut O, Tezel I. Th e relationship between shoulder pain and damage to the cervical plexus following neck dissection. Eur Arch Otorhinolaryngol 2007; 264: 1333-8.