Accessory Nerve Function After Modified Radical and Lateral Neck Dissections

• Published in: The Laryngoscope Vol. 110; no. 1; pp. 73 - 77
• Main Authors: Köybasioglu, Ahmet, Tokcaer, Ayse Bora, Uslu, S. Sabri, Ileri, Fikret, Beder, Levent, Özbilen, Suat
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ John Wiley & Sons, Inc 01-01-2000; Wiley-Blackwell
• Subjects: Accessory nerve; Accessory Nerve - physiopathology; Action Potentials; Biological and medical sciences; Chi-Square Distribution; dysfunction; Electric Stimulation - methods; electromyography; Electromyography - statistics & numerical data; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Laryngeal Neoplasms - physiopathology; Laryngeal Neoplasms - surgery; lateral neck dissection; Lymph Node Excision - methods; Lymph Node Excision - statistics & numerical data; Male; Medical sciences; Middle Aged; modified radical neck dissection; Neck; Observer Variation; Postoperative Period; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Tropical medicine; Human; Postoperative; Nervous system diseases; Carcinoma; Lateral; Malignant tumor; Morbidity; Accessory nerve; Electrodiagnosis; Radical resection; Surgery; ENT disease; Complication; Electromyography; Larynx; Larynx disease; Peripheral nerve disease; Neck; Technique; Dissection; Comparative study
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-200001000-00014

Objectives: Evaluate preoperative and postoperative electrophysiological changes related to the accessory nerve with reference to dissection technique, modified radical neck dissection, and lateral neck dissection.
Study Design: Prospective electrophysiological analysis of accessory nerve function in a total of 20 laryngeal carcinoma patients after neck dissection, 12 being lateral neck dissection (4 bilateral) and 8 being modified radical neck dissection.
Methods: Distal latencies, compound muscle action potentials, and electromyography findings were investigated before surgery and, in early and late postoperative periods in 20 laryngeal carcinoma patients. Results were evaluated by Student t test and χ2 test for intragroup and intergroup differences.
Results: In the lateral neck dissection group, postoperative distal latencies were longer, without statistical significance, whereas in the modified radical neck dissection group postoperative latencies were statistically longer. Postoperative compound muscle action potentials were significantly lower in both groups. Electromyographic work‐up showed deterioration in early postoperative periods and improvement in late postoperative periods. When intergroup differences were compared, both postoperative compound muscle action potential and electromyographic findings were worse in the lateral neck dissection group.
Conclusions: The accessory nerve function after modified radical neck dissection is better than function after lateral neck dissection because of increased stress applied to the nerve during retraction of the sternocleidomastoid muscle for achievement of a better exposed surgical field in lateral neck dissection.