An audit into the incidence of handicap after unilateral radical neck dissection

Abstract

Forty-six patients who had undergone a radical neck dissection more than six months previously were assessed to determine the degree of handicap that results from division of the accessory nerve. Employment problems, amount of pain, and social and recreational difficulties were assessed. Forty-six per cent of those in employment prior to their operation gave up their work specifically because of problems with their shoulder; this affected more manual than non-manual workers (11 out of 20 manual compared with zero out of four non-manual). Thirty per cent complained of moderately severe or severe pain related to the shoulder. The amount of pain could not be correlated with age, sex, side of operation in relation to handedness, physical build of the patient, or whether the patient had been treated with radiotherapy. Although this is the largest study to address this question since that of Ewing and Martin in 1952, the small numbers involved mean that if any such correlation exists then it may not have become apparent. In view of this incidence of pain and occupational handicap, we feel that efforts should be made to preserve accessory nerve function in cases where surgical clearance of the tumour field is not compromised as a result.

Disability in Patients With Head and Neck Cancer

“…These results are similar to those of another study in which 48% of the patients who were employed before undergoing surgery with a neck dissection were unable to return to work afterwards. 13 These data also confirm findings in previous neck dissection studies in which patients who underwent neck dissections had increased levels of pain, weakness, and overall loss of function.…”

Neuropatias do nervo acessório espinhal secundárias a cirurgias cervicais: estudo clínico e eletrofisiológico de sete casos

“…Os sintomas motores encontrados em nossos casos (Tabela 2) e os descritos na literatura 2,9,11,19,20 não são uniformes. Os casos 1 e 3 apresentavam paralisia da elevação do braço e ombro, que no Caso 1 se acompanhava de hipotrofia grave do feixe superior do trapézio (Fig 1); os Casos 4, 5, e 7, paralisias da elevação do braço; o Caso 6 apenas déficit da elevação do ombro e o Caso 2, discutível escápula alada.…”

“…Alguns livros-texto de anatomia 2 e neurologia 19 referem como sinal principal de lesão do nervo espinhal a paralisia da elevação do ombro, que costuma ser o sinal mais pesquisado na semiologia neurológica. Achamos que é recomendável avaliar também a força da elevação do braço 20 e conferir a possível presença de escápula alada.…”

Psychological factors associated with head and neck cancer treatment and survivorship: Evidence and opportunities for behavioral medicine.

“…These treatments are associated with a range of side effects including difficulties with essential functioning such as eating, swallowing, breathing, and speech, as well as loss of taste and smell, decreased sensation, excessive dry mouth, residual pain and swelling, and facial disfigurement (Brockstein & Masters, 2010; List & Bilir, 2004). Moreover, disease and treatment confer marked disability, with nearly half of patients unable to return to work for a substantial period of time beyond treatment cessation (Shone & Yardley, 1991; Taylor et al, 2004). Consequently, HNC survivors often require extensive rehabilitative treatment including speech therapy, swallowing rehabilitation, and dental/maxillofacial rehabilitation, as well as physical and occupational therapies (Ward & Van As-Brooks, 2006).…”