Pain, Quality of Life, and Spinal Accessory Nerve Status After Neck Dissection

• Published in: The Laryngoscope Vol. 110; no. 4; pp. 620 - 626
• Main Authors: Terrell, Jeffrey E., Welsh, Deborah E., Bradford, Carol R., Chepeha, Douglas B., Esclamado, Ramon M., Hogikyan, Norman D., Wolf, Gregory T.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ John Wiley & Sons, Inc 01-04-2000; Wiley-Blackwell
• Subjects: Accessory Nerve - surgery; Adult; Aged; Biological and medical sciences; Female; functional neck dissection; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; health status; health status assessment; Humans; Male; Medical sciences; Middle Aged; modified radical neck dissection; Neck Dissection; Neck Pain - etiology; Neoplasm Staging; Otorhinolaryngologic Neoplasms - pathology; Otorhinolaryngologic Neoplasms - radiotherapy; Otorhinolaryngologic Neoplasms - surgery; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; pain; Pain Measurement; Pain, Postoperative - etiology; Quality of Life; Radical neck dissection; Radiotherapy, Adjuvant; selective neck dissection; shoulder pain; Shoulder Pain - etiology; Sickness Impact Profile; spinal accessory nerve; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Tumors; Human; Squamous cell carcinoma; Prognosis; Preservation; Surgical resection; Malignant tumor; Spinal nerve; Accessory nerve; Quality of life; Survey; Pain; Treatment; Surgery; Head and neck; ENT disease; Neck; Dissection
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-200004000-00016

Objective To assess quality of life (QOL) in patients with head and neck cancer who underwent neck dissection and to compare QOL scores for patients in whom the spinal accessory nerve (CN XI) was resected or preserved.
Setting and Design and Outcomes Measures Three hundred ninety‐seven patients who had undergone treatment for head and neck cancer completed the University of Michigan Head and Neck Quality of Life (HNQOL) instrument, the Medical Outcomes Study SF‐12 General Health Survey, and questions on “pain despite pain medications” and headaches.
Results Of the 397 patients, 222 had no neck dissection, 46 had neck dissections resecting CN XI, and 129 had dissection sparing CN XI. Of the latter group, 68 patients had dissections sparing level V and 61 dissections included level V. Age, sex, primary site distribution, and T stage were not different between the groups. Patients who had neck dissections sparing CN XI had better scores on the HNQOL pain domain (P = .002), had less shoulder or neck pain (P = .003), and took pain medications less frequently (P = .0004) compared with patients who had neck dissections sacrificing CN XI. When CN XI was preserved, patients who had no level V dissection had better pain domain scores (P = .03) and eating domain scores (P = .007) on the HNQOL, had less shoulder or neck pain (P = .006), and had less physical problems (P = .03) than patients who had level V dissected. On multivariate analysis, pain‐related QOL scores after neck dissection were significantly better (P < .01) if patients had dissections with preservation of CN XI and if level V was not dissected.
Conclusion Neck dissections sparing CN XI are associated with better pain scores on the HNQOL, less shoulder and neck pain, and less need for medications. When CN XI is spared, not dissecting level V of the neck is associated with better HNQOL pain scores, less shoulder or neck pain, and fewer physical problems.