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Introduction: Reconstruction of major head and neck defects remains challenging for head and neck surgeons . As esthetic expectations are extremely demanding, in terms of colormatch, texture and functional dexterity. Reconstructive options range widely from skin grafts tolocoregional or even free flaps. The need of the hour would be a versatile flap that harbours only the desired characteristics of both local and free flaps.

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Objective: This report aims at highlighting the persistence of diphtheria in India and the need for better vaccine coverage of both primary as well as booster doses and accessibility of antidiphtheric serum (ADS) at all tertiary medical centers.Case report: An 11-year-old girl, previously unimmunized against diphtheria, presented with history of fever, cough, difficulty in swallowing and change in voice within 1 week duration. Examination revealed bilaterally enlarged tonsils with a grayish white patch over them. A provisional diagnosis of faucial diphtheria and the patient was started on antibiotics.Next day, child developed respiratory distress and generalized swelling over the neck. An emergency tracheotomy was performed, and shifted to a center where ADS was available. She received 5 doses of ADS but succumbed to myocarditis 5 days later. Membranous patches removed from the trachea were positive for Corynebacterium diphtheriae and the diagnosis was confirmed by culture. Conclusion:Vaccination coverage for both primary as well as boosters should be improved, so as to reach coverage advocated by WHO. All tertiary hospitals should have ADS. Health care personal should be sensitized to maintain a high degree of suspicion when presented with a patch over the tonsil.

Aims To assess preoperative and postoperative shoulder function by electromyography (EMG) in spinal accessory nerve (SAN) sparing neck dissections in head and neck cancers. Materials and methods A prospective study was done on 50 patients (51 shoulders) with histopathologically proven head and neck cancers with N0 or N1 neck who underwent nerve sparing neck dissections. Patients were assessed preoperatively and postoperatively at 3 weeks and 3 months by needle EMG and muscle strength tests of upper trapezius. Results and interpretation: At 3 weeks postoperatively, 11 shoulders (39.3%) in FND group and four shoulders (33.3%) in modified radical neck dissection (MRND) group showed severely abnormal EMG, while in supraomohyoid neck dissection (SOHND) group only two (18.2%) shoulders showed severely abnormal EMG. All patients who underwent nerve sparing neck dissections showed improvement in at least one category on the second electromyogram at 3 months. This could be attributed to neuropraxia or transient devascularization of the accessory nerve. In our study, 11 patients in FND group showed severely abnormal EMG finding, but they did not have as great a degree of shoulder dysfunction as would be expected. This could be due to factors like preoperative condition of other synergistic shoulder girdle muscles, postoperative exercises, etc. Conclusion SAN injuries are common in all types of nerve sparing neck dissections requiring aggressive physiotherapy for an improved shoulder function. To conclude, in patients in whom it is oncologically sound, nerve sparing neck dissections offers significant benefit in terms of shoulder function. How to cite this article Mohiyuddin A, Raj S, Merchant S, Oomen, Kottaram PJ. Electromyographic Assessment of Accessory Nerve Function Following Nerve Sparing Neck Dissection. Int J Head and Neck Surg 2013;4(1):19-23.