Assessment of shoulder impairment after functional neck dissection: Long term results

Background Selective neck dissection (SND) is a mainstay of head and neck cancer treatment. A common sequela is shoulder syndrome from spinal accessory nerve (SAN) trauma. Extensive dissection in neck levels 2 and 5 leads to SAN dysfunction. However, it is not known whether limited level 2 dissection reduces SAN injury. The purpose of this double‐blind randomized controlled trial was to determine whether omitting level 2b dissection would improve shoulder‐related quality of life and function. Methods Patients with head and neck cancers undergoing surgery were randomized 1:1 to SND without level 2b dissection (group 1) or with it (group 2) on their dominant‐hand side. Patients, caregivers, and assessors were blinded. The primary outcome was the change in the Neck Dissection Impairment Index (NDII) score after 6 months. An a priori calculation of the minimally important clinical difference in the NDII score was determined to establish a sample size of 15 patients per group (power = 0.8). Secondary outcomes included shoulder strength and range of motion (ROM) and SAN nerve conduction. The trial was registered at ClinicalTrials.gov (NCT00765791). Results Forty patients were enrolled, and 30 were included (15 per group). Six months after the surgery, group 2 demonstrated a significant median decrease in the NDII from the baseline (30 points) and in comparison with group 1, whose NDII dropped 17.5 points (P = .02). Shoulder ROM and SAN conduction demonstrated significant declines in group 2 (P ≤ .05). No adverse events occurred. Conclusions Level 2b should be omitted in SND when this is oncologically safe and feasible. This allows for an optimal balance between function and cancer cure.

show abstract

“…SND limits lymph node dissection to preserve shoulder function . SAN dysfunction in SND occurs with level 2a/2b dissection .…”

Section: Discussionmentioning

confidence: 99%

“…Rather, the loss of motion was linked to losses in nerve function. Although the progressive resistance exercise training program helps to minimize fibrotic changes and preserve shoulder‐joint/soft‐tissue mobility, it cannot fully compensate for the loss of nerve function …”

Section: Discussionmentioning

confidence: 99%

2b or not 2b? Shoulder function after level 2b neck dissection: A double‐blind randomized controlled clinical trial

Dziegielewski

McNeely

Ashworth

et al. 2019

Cancer

View full text Add to dashboard Cite

show abstract

“…Several authors have hypothesized about the causes of accessory neuropraxia during surgery that preserves the nerve anatomically, including traction, skeletonization of the nerve, microtrauma, or devascularization 26. These causes may explain the segmental demyelination and subsequent neuropraxia 27.…”

Section: Shoulder Complaints After Neck Dissectionmentioning

confidence: 99%

Neck treatment and shoulder morbidity: Still a challenge

et al. 2010

View full text Add to dashboard Cite

Shoulder complaints and functional impairment are common sequelae of neck dissection. This is often attributed to injury of the spinal accessory nerve by dissection or direct trauma. Nevertheless, shoulder morbidity may also occur in cases in which the spinal accessory nerve has been preserved. In this article, the physiology and pathophysiology of the shoulder are discussed, followed by a consideration of the impact of neck dissection on shoulder complaints, functional impairment, and quality of life. Finally, rehabilitation will be considered.

show abstract

“…These sequelae can also be seen after selective neck dissection, although the severity and chronicity seem to be less. [5][6][7] This phenomenon is felt to be secondary to devascularization of the spinal accessory nerve during extensive dissection, seen more with dissection of level 5, leading to temporary or permanent accessory nerve weakness. 8,9 Rehabilitation for this dysfunction comes in the form of stretching exercises, occupational therapy, or physical therapy (PT).…”

mentioning

confidence: 99%

Shoulder function in patients undergoing selective neck dissection with or without radiation and chemotherapy

et al. 2010

View full text Add to dashboard Cite

show abstract

Assessment of shoulder impairment after functional neck dissection: Long term results

Cited by 32 publications

References 20 publications

2b or not 2b? Shoulder function after level 2b neck dissection: A double‐blind randomized controlled clinical trial

2b or not 2b? Shoulder function after level 2b neck dissection: A double‐blind randomized controlled clinical trial

Neck treatment and shoulder morbidity: Still a challenge

Shoulder function in patients undergoing selective neck dissection with or without radiation and chemotherapy

Contact Info

Product

Resources

About