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Iritani Y, Kato H, Kaneko Y, Ishihara T, Ando T, Kawaguchi M, Shibata H, Ogawa T, Noda Y, Hyodo F, Matsuo M. FDG uptake in the cervical muscles after neck dissection: imaging features and postoperative natural course on 18F‑FDG‑PET/CT. Jpn J Radiol 2024:10.1007/s11604-024-01568-6. [PMID: 38658502 DOI: 10.1007/s11604-024-01568-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE This study aimed to assess the imaging features and postoperative natural course of 18F-fluorodeoxyglucose (FDG) uptake in the cervical muscles after neck dissection. MATERIALS AND METHODS This study included 83 patients who underwent preoperative and postoperative 18F-FDG-PET/CT and were diagnosed with head and neck malignancy after neck dissection. Postoperative 18F-FDG-PET/CT was performed within 5 years after neck dissection. Preoperative and postoperative FDG uptake of the trapezius, sternocleidomastoid, scalene, pectoralis major, and deltoid muscles was visually assessed. Increased postoperative uptake was visually defined as higher postoperative FDG uptake than the preoperative one in the corresponding muscle. The maximum standardized uptake value (SUVmax) was measured in cases with increased postoperative uptakes. RESULTS Increased postoperative uptakes were observed in 43 patients (52%). The trapezius (31/83, 37%), sternocleidomastoid (19/83, 23%), and scalene (12/83, 14%) muscles were involved, as opposed to the pectoralis major and deltoid muscles were not. Increased postoperative uptakes were observed on the dissected side in all 43 patients. Significant differences between SUVmax estimated from the mixed-effects model and postoperative months were observed in the trapezius muscle (Coefficient (β) = -0.038; 95% confidence interval (CI): [-0.047, -0.028]; p < 0.001) and sternocleidomastoid muscle (β = -0.015; 95% CI: [-0.029, -0.001]; p = 0.046). CONCLUSIONS Increased postoperative uptakes in the cervical muscles were observed on the dissected side in approximately half of the patients after neck dissection. The SUVmax in the trapezius and sternocleidomastoid muscles decreased after surgery over time.
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Affiliation(s)
- Yukako Iritani
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Yo Kaneko
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan
| | - Tomohiro Ando
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masaya Kawaguchi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | | | - Takenori Ogawa
- Department of Otolaryngology, Gifu University, Gifu, Japan
| | - Yoshifumi Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Fuminori Hyodo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
- Center for One Medicine Innovative Translational Research (COMIT), Institute for Advanced Study, Gifu University, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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Fidancı H, Buturak Ş, Öztürk İ, Arlıer Z. Needle electromyography abnormalities in the upper trapezius muscle in neuromuscular disorders. Turk J Med Sci 2023; 53:233-242. [PMID: 36945948 PMCID: PMC10387837 DOI: 10.55730/1300-0144.5578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/22/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND : Needle electromyography (EMG) abnormalities in the trapezius muscle (TM) can be seen in neuromuscular disorders. The aim was to determine the characteristics of needle EMG abnormalities observed in the TM in neuromuscular disorders. METHODS The data of patients who applied to the Clinical Neurophysiology Laboratory of University of Health Sciences Adana City Training and Research Hospital between December 2018 and October 2021 were reviewed. Polio survivors, amyotrophic lateral sclerosis (ALS) patients, patients with sensorimotor polyneuropathy, patients with spinal cord lesions involving C2/C3/C4 segments, patients with spinal accessory nerve (SAN) lesions, neuralgic amyotrophy (NA) patients, and patients with myopathy were included. Needle EMG findings of the upper TM of the patients were analyzed. Positive sharp waves, fibrillation potentials, fasciculation potentials, myotonic discharges, and motor unit action potential (MUAP) changes were considered needle EMG abnormalities. RESULTS Eighty-one polio survivors, 23 ALS patients, 39 patients with sensorimotor polyneuropathy, 10 patients with cervical spinal lesions, eight NA patients, seven patients with SAN lesions, and three patients with myopathy were included in the study. Fifteen (65.2%) ALS patients, 18 (22.2%) polio survivors, three (30%) patients with cervical spinal lesions, two (5.1%) patients with sensorimotor neuropathy, one (12.5%) NA patient, seven (100%) patients with SAN lesions, and two (66.7%) patients with myopathies had at least one needle EMG abnormality in the TM. Fasciculation potentials in the TM were seen in 10 (43.5%) ALS patients. In four patients with SAN lesions and one polio survivor, MUAP could not be obtained from the TM. DISCUSSION There may be more frequent needle EMG abnormalities, particularly in ALS patients and patients with SAN lesions. Since the number of patients with myopathy included in this study was low, it is difficult to comment on the needle EMG features of the TM for these patients. In addition, this study indicated that fasciculation potentials in the TM are typical in ALS patients and that MUAP may not be obtained from the TM in patients with SAN lesions.
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Affiliation(s)
- Halit Fidancı
- Division of Clinical Neurophysiology, Department of Neurology,University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Şencan Buturak
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - İlker Öztürk
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Zülfikar Arlıer
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
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Chen YH, Liang WA, Lin CR, Huang CY. A randomized controlled trial of scapular exercises with electromyography biofeedback in oral cancer patients with accessory nerve dysfunction. Support Care Cancer 2022; 30:8241-8250. [PMID: 35821447 DOI: 10.1007/s00520-022-07263-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aims to investigate the effects of electromyography (EMG) biofeedback on scapular positions and muscle activities during scapular-focused exercises in oral cancer patients with accessory nerve dysfunction. METHODS Twenty-four participants were randomly allocated to the motor-control with biofeedback group (N = 12) or the motor-control group (N = 12) immediately after neck dissection. Each group performed scapular-focused exercises with conscious control of scapular orientation for 3 months. EMG biofeedback of upper trapezius (UT), middle trapezius (MT), and lower trapezius (LT) was provided in the motor-control with biofeedback group. Scapular symmetry measured by modified lateral scapular slide test; shoulder pain; active range of motion (AROM) of shoulder abduction; upper extremity function; maximal isometric muscle strength of UT, MT, and LT; and muscle activities during arm elevation/lowering in the scapular plane were evaluated at baseline and the end of the intervention. RESULTS After the 3-month intervention, only the motor-control with biofeedback group showed improving scapular symmetry. Although both groups did not show significant improvement in shoulder pain, increased AROM of shoulder abduction and muscle strength of the UT and MT were observed in both groups. In addition, only the motor-control with biofeedback group had improved LT muscle strength, upper extremity function, and reduced UT and MT muscle activations during arm elevation/lowering. CONCLUSIONS Early interventions for scapular control training significantly improved shoulder mobility and trapezius muscle strength. Furthermore, by adding EMG biofeedback to motor-control training, oral cancer patients demonstrated greater effectiveness in stabilizing scapular position, muscle efficiency, and upper extremity function than motor-control training alone. TRIAL REGISTRATION Institutional Review Board: This study was approved by the Chang Gung Medical Foundation Institutional Review Board (Approval No: 201901788A3. Approval Date: 2 January, 2020). CLINICAL TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov (ClinicalTrials.gov ID: NCT04476004. Initial released Date: 16 July, 2020).
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Affiliation(s)
- Yueh-Hsia Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, 100, Taiwan.,Rehabilitation Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan City, Taiwan
| | - Wei-An Liang
- Rehabilitation Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan City, Taiwan
| | - Chi-Rung Lin
- Rehabilitation Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan City, Taiwan
| | - Cheng-Ya Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, 100, Taiwan.
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Imai T, Sato Y, Abe J, Kumagai J, Morita S, Saijo S, Yamazaki T, Asada Y, Matsuura K. Shoulder function after neck dissection: Assessment via a shoulder-specific quality-of-life questionnaire and active shoulder abduction. Auris Nasus Larynx 2020; 48:138-147. [PMID: 32709371 DOI: 10.1016/j.anl.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/12/2020] [Accepted: 07/01/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Neck dissection results in a high probability of postoperative shoulder functional impairment, even when the spinal accessory nerve is preserved. Therefore, surgeons must inform patients about the expected functional and qualitative recovery of shoulder function after surgery. METHODS The present study included a prospective cohort of 66 patients (85 neck dissection sides) who underwent neck dissection between December 2015 and July 2017 at a single institution. The active shoulder abduction angles of the affected side and the patient-reported shoulder-specific quality-of-life recovery score of the Western Ontario Rotator Cuff (WORC) questionnaire were examined at 1, 3, 6, 9, and 12 months postoperatively. Additionally, the association between these outcomes and risk factors for shoulder impairment were investigated. RESULTS The average active shoulder abduction angles were significantly improved at 3 and 6 months postoperatively compared with 1 month postoperatively (96.5 ± 4.3° at 1 month versus 110.1 ± 4.7° at 3 months, p = 0.035, and versus 142.0 ± 4.6° at 6 months, p < 0.0001). The proportion of patients who were unable to abduct their shoulders by 150° or more was significantly lower at 6 months postoperatively (41.5%) compared with 1 month postoperatively (82.4%, p < 0.0001). The WORC score significantly improved from 60.4 ± 2.4% at 1 month postoperatively to 67.9 ± 2.6% at 6 months postoperatively (p = 0.036). Multivariate analysis revealed that postoperative radiotherapy was a significant risk factor for shoulder impairment at 3 and 6 months postoperatively (p = 0.003 and p = 0.027, respectively), and that level V dissection and head and neck irradiation were significant risk factors for a worse shoulder outcome at 6 and 9 months postoperatively (respective p values for level V dissection and head and neck irradiation were p = 0.049 and p = 0.030 at 6 months postoperatively, and p = 0.016 and p = 0.013 at 9 months postoperatively). CONCLUSION Satisfactory functional and qualitative recovery of shoulder function was achieved at 6 months after neck dissection. Postoperative radiotherapy was a predictor of poor shoulder function in the early postoperative period; both level V dissection and head and neck irradiation were predictors of poor shoulder function at 6 and 9 months after neck dissection.
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Affiliation(s)
- Takayuki Imai
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori 981-1293, Miyagi, Japan.
| | - Yuki Sato
- Department of Rehabilitation, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Jun Abe
- Department of Rehabilitation, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Jun Kumagai
- Department of Orthopaedic Surgery, Akaishi Hospital, Shiogama, Miyagi, Japan; Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Yamagata, Japan
| | - Sinkichi Morita
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori 981-1293, Miyagi, Japan
| | - Satoshi Saijo
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori 981-1293, Miyagi, Japan
| | - Tomoko Yamazaki
- Department of Head and Neck Medical Oncology, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Yukinori Asada
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori 981-1293, Miyagi, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori 981-1293, Miyagi, Japan; Department of Head and Neck Surgery, National Cancer Center East, Kashiwa, Chiba, Japan
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Pantvaidya G, Rao K, D'Cruz A. Management of the neck in oral cancers. Oral Oncol 2020; 100:104476. [DOI: 10.1016/j.oraloncology.2019.104476] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 12/30/2022]
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Demirhan H, Hamit B, Yiğit Ö. Cervical Vestibular Evoked Myogenic Potentials (cVEMPs) Evoked by Air-Conducted Stimuli in Patients with Functional Neck Dissection. J Natl Med Assoc 2018; 110:281-286. [PMID: 29778132 DOI: 10.1016/j.jnma.2017.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/10/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Cervical vestibular-evoked myogenic potentials (cVEMPs) are short-latency vestibulocollic reflexes. The damage on any point of the vestibulocollic reflex pathway could affect the cVEMPs. Whether neck dissection has an effect on the sacculocollic pathway, and consequently on cVEMPs, remains unexplored. The aim of this study was to evaluate the cVEMP findings in patients with functional neck dissection without vestibular symptoms. PATIENTS AND METHODS This cross-sectional study design, 20 patients who had undergone unilateral neck dissection with sparing of the accessory nerve, SCM and internal jugular vein, were included. The response rates (%), cVEMPs parameters such as the prestimulus background EMG [Root mean square (RMS)] activity (μV), P13 and N23 peak latencies (ms), interpeak (N23-P13) interval (ms), scale and non-scale interpeak (N23-P13) amplitudes (μV) were compared between the groups. Amplitude asymmetry ratio (AAR) was calculated. RESULTS Twenty patients (14 males and 6 females), age was between 38 and 79 years were included in the study. All of the patients had clear cVEMPs on the NOS, whereas 18/20 (90%) patients had on the NDS. P13 and N23 peak latency of the NDS were found to be significantly longer than the NOS (P = 0.01). There was no significant difference in N23-P13 interpeak interval between two sides (P > 0.05). There was a negative correlation between P13 peak latency and post-operative time (P = 0.042; R = ‑0.484). Scale and non-scale N23-P13 interpeak amplitudes of the NDS were found to be significantly lower than the NOS (P = 0.03). Mean AAR was found as 0.28 ± 0.16 (0.08-0.76). Seven patients (35%) had abnormal amplitude asymmetry. RMS values, were statistically and significantly lower in NDS compared to NOS (P = 0.01). However, no correlation was observed between the RMS values and peak latency and peak amplitude values (P > 0.05). CONCLUSIONS cVEMP testing is an easy-to-apply, non-invasive, painless, and recordable test that can be used for evaluations of SAN and SCM function for patients undergoing neck dissection. After neck dissection, VEMP abnormalities can be detected. However, further studies are needed to indicate whether these abnormalities originate within the vestibular system and are due to pathologies originating from the SANs and SCMs. In addition, preoperative and postoperative studies are needed to better guide the clinical application of cVEMP testing.
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Affiliation(s)
- Hasan Demirhan
- Department of Otorhinolaryngology, İstanbul Training and Research Hospital, İstanbul, Turkey.
| | - Bahtiyar Hamit
- Department of Otorhinolaryngology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Özgür Yiğit
- Department of Otorhinolaryngology, İstanbul Training and Research Hospital, İstanbul, Turkey
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Reddy GRK, Hulikal N, Lakshmi AY, Vengamma B. Nerve and vein preserving neck dissections for oral cancers: a prospective evaluation of spinal accessory nerve function and internal jugular vein patency following treatment. ACTA ACUST UNITED AC 2017; 38:7-12. [PMID: 29087403 DOI: 10.14639/0392-100x-1481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/11/2017] [Indexed: 11/23/2022]
Abstract
Nerve and vein preserving modification of the radical neck dissection is commonly used in the management of oral squamous cell cancers. There is limited literature addressing nerve function and vein patency following treatment. We prospectively analysed 65 patients with nerve conduction study using surface electromyography at baseline, 1 month and 6 months post-surgery and colour Doppler of the internal jugular vein at baseline and 1 month post-surgery. We also studied functional outcomes of nerve sparing with arm abduction test and Neck Dissection Quality of Life questionnaire. There was a statistically significant increase in mean latency of motor action potential and decrease in the mean amplitude of the motor action potential following surgery, suggesting nerve dysfunction. Following surgery, there was a significant decrease in the diameter of the vein as well as an increase in the velocity of blood flow; there was partial thrombus in 5% of individuals. In conclusion, even though nerve dysfunction compromised shoulder abduction, vein dysfunction rarely resulted in any significant clinical impact.
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Affiliation(s)
- G R Kumar Reddy
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - N Hulikal
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - A Y Lakshmi
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - B Vengamma
- Department of Neurology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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The impact on post-operative shoulder function of intraoperative nerve monitoring of cranial nerve XI during modified radical neck dissection. Eur Arch Otorhinolaryngol 2016; 273:4445-4451. [DOI: 10.1007/s00405-016-4096-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
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Lanisnik B, Zargi M, Rodi Z. Electrophysiologic analysis of injury to cranial nerve XI during neck dissection. Head Neck 2015; 38 Suppl 1:E372-6. [PMID: 25580708 DOI: 10.1002/hed.24002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Despite preservation of the accessory nerve, a considerable number of patients report partial nerve damage after modified radical neck dissection (MRND) and selective neck dissection. METHODS Accessory nerve branches for the trapezius muscle were stimulated during neck dissection, and the M wave amplitude was measured during distinct surgical phases. RESULTS The accessory nerve was mapped in 20 patients. The M wave recordings indicated that major nerve damage occurred during dissection at levels IIa and IIb in the most proximal segment of the nerve. The M waves evoked from this nerve segment decreased significantly during surgery (analysis of variance; p = .001). CONCLUSION The most significant intraoperative injury to the accessory nerve during neck dissection occurs at anatomic nerve levels IIa and IIb. © 2015 Wiley Periodicals, Inc. Head Neck 38: E372-E376, 2016.
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Affiliation(s)
- Bostjan Lanisnik
- Department of ENT-Head and Neck Surgery, University Medical Center, Maribor, Slovenia
| | - Miha Zargi
- University Clinic for ENT and Cervicofacial Surgery, University Medical Center, Ljubljana, Slovenia
| | - Zoran Rodi
- Institute for Clinical Neurophysiology, University Medical Center, Ljubljana, Slovenia
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Identification of three anatomical patterns of the spinal accessory nerve in the neck by neurophysiological mapping. Radiol Oncol 2014; 48:387-92. [PMID: 25435852 PMCID: PMC4230559 DOI: 10.2478/raon-2013-0069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 09/03/2013] [Indexed: 12/16/2022] Open
Abstract
Background In spite of preservation of the accessory nerve there is still considerable proportion of patients with partial nerve damage during modified radical neck dissection (MRND). Methods The nerve was identified during the surgery and its branches for the trapezius muscle mapped with nerve monitor. Results The accessory nerve was mapped during 74 hemineck dissections and three patterns were identified. In type 1 nerve exits at the posterior end of the sternocleidomastoid muscle (SCm) and then it enters the level V (66%). In type 2 the nerve for trapezius muscle branches off before entering the SCm (22%). In type 3 the nerve exits at the posterior part of the SCm and it joins to the cervical plexus (12%). The nerve than exits this junction more medially as a single trapezius branch. Conclusions The description of three anatomical patterns in level II and V could help preserving the trapezius branch during MRND.
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Birinci Y, Genc A, Ecevit MC, Erdag TK, Guneri EA, Oztura I, Evlice A, Ikiz AO. Spinal Accessory Nerve Monitoring and Clinical Outcome Results of Nerve-Sparing Neck Dissections. Otolaryngol Head Neck Surg 2014; 151:253-9. [DOI: 10.1177/0194599814531021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/19/2014] [Indexed: 11/17/2022]
Abstract
Objective To investigate the role of intraoperative spinal accessory nerve monitoring in predicting postoperative shoulder function in spinal accessory nerve-sparing neck dissections. Study Design Prospective, double-blind clinical trial. Setting Academic, tertiary care center. Subjects and Methods This study was performed on 20 neck sites of 17 consecutive patients who had neck dissections sparing the spinal accessory nerve. Threshold increment ≥0.25 mA and amplitude decrement ≥72% were classified as significant intraoperative neuromonitoring changes while lesser differences were classified as insignificant intraoperative neuromonitoring changes. All patients had intraoperative neuromonitoring recordings when the spinal accessory nerve was first identified and at the end of surgery. Postoperative shoulder function was evaluated neurophysiologically with electromyography and clinically with Constant-Murley Score; daily activity restrictions were evaluated with Activity Restriction Scale. Results Clinical assessment of shoulder functions at postoperative first and second months showed statistically significant deteriorations when compared with preoperative values ( P < .05). The shoulder function deterioration was statistically significantly less for patients with insignificant intraoperative neuromonitoring changes than patients with significant intraoperative neuromonitoring changes ( P < .05). Daily activity restriction deteriorations were present in both groups at first postoperative month ( P < .05). While they persisted in the group with significant intraoperative neuromonitoring changes during the second postoperative month ( P < .05), there was continuing recovery in the insignificant intraoperative neuromonitoring change group and statistical significance disappeared ( P > .05). Conclusion Our results support the predictive value of spinal accessory nerve intraoperative neuromonitoring for determining shoulder function deterioration and activity restriction scores.
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Affiliation(s)
- Yucel Birinci
- Department of Otolaryngology-Head and Neck Surgery, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey
| | - Arzu Genc
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Inciraltı, Izmir, Turkey
| | - Mustafa Cenk Ecevit
- Department of Otolaryngology-Head and Neck Surgery, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey
| | - Taner Kemal Erdag
- Department of Otolaryngology-Head and Neck Surgery, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey
| | - Enis Alpin Guneri
- Department of Otolaryngology-Head and Neck Surgery, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey
| | - Ibrahim Oztura
- Department of Neurology, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey
| | - Ahmet Evlice
- Department of Neurology, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey
| | - Ahmet Omer Ikiz
- Department of Otolaryngology-Head and Neck Surgery, Dokuz Eylul University Faculty of Medicine, Inciraltı, Izmir, Turkey
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Onizuka T. [Purpose of nerve preservation and reconstruction for neck dissection]. NIHON JIBIINKOKA GAKKAI KAIHO 2013; 116:1146-1147. [PMID: 24588046 DOI: 10.3950/jibiinkoka.116.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Goldstein DP, Ringash J, Bissada E, Jaquet Y, Irish J, Chepeha D, Davis AM. Scoping review of the literature on shoulder impairments and disability after neck dissection. Head Neck 2013; 36:299-308. [DOI: 10.1002/hed.23243] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2012] [Indexed: 11/06/2022] Open
Affiliation(s)
- David P. Goldstein
- Department of Surgical Oncology; Princess Margaret Hospital; Department of Otolaryngology - Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
| | - Jolie Ringash
- Department of Radiation Oncology; Princess Margaret Hospital; University of Toronto; Toronto Ontario Canada
| | - Eric Bissada
- Department of Surgical Oncology; Princess Margaret Hospital; Department of Otolaryngology - Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
| | - Yves Jaquet
- Department of Surgical Oncology; Princess Margaret Hospital; Department of Otolaryngology - Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
| | - Jonathan Irish
- Department of Surgical Oncology; Princess Margaret Hospital; Department of Otolaryngology - Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
| | - Douglas Chepeha
- Department of Otolaryngology - Head and Neck Surgery; University of Michigan; Ann Arbor Michigan
| | - Aileen M. Davis
- Division of Health Care and Outcomes Research; Toronto Western Research Institute; University Health Network; University of Toronto; Toronto Ontario Canada
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Parikh S, Tedman BM, Scott B, Lowe D, Rogers SN. A double blind randomised trial of IIb or not IIb neck dissections on electromyography, clinical examination, and questionnaire-based outcomes: a feasibility study. Br J Oral Maxillofac Surg 2011; 50:394-403. [PMID: 21996573 DOI: 10.1016/j.bjoms.2011.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 09/07/2011] [Indexed: 10/16/2022]
Abstract
The aim of this double-blind randomised controlled trial was to evaluate the feasibility of a study to compare differences using electromyographic (EMG) or nerve conduction studies (NCS), questionnaires completed by patients, and range of movement, after selective supraomohyoid neck dissection in patients with and without level IIb for node-negative oral cancer. Between January 2006 and July 2008 we recruited 57 previously untreated consecutive patients with node-negative T1 or T2 squamous cell carcinomas (SCC) of the anterior two-thirds of the tongue and floor of the mouth. Thirty-eight patients were randomised (32 unilateral and 6 bilateral dissections) into two groups. Preoperatively and at 6 weeks postoperatively we collected EMG or NCS data on trapezius muscle activity (primary outcome), the University of Washington quality of life scale (UWQoLv4), the neck dissection impairment index (NDII), and range of movement. At 6 months data on range of movement and data from the questionnaires were obtained. There was a greater mean fall in trapezius M-response amplitude for those who had IIb dissected, which suggested that inclusion of this level caused additional morbidity. However, it was not significant for patients who had unilateral dissections or for all necks combined. Changes in M-amplitude from baseline to 6 weeks, and from baseline to 6 months were strongly associated with changes in the shoulder domain of the UWQoL and the NDII, but were less strong for change in range of movement. This feasibility study has shown that a randomised controlled trial (RCT) is achievable. The combination of EMG or NCS with questionnaire data preoperatively and to 6 weeks would suffice and would simplify a new study design.
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Affiliation(s)
- S Parikh
- Regional Maxillofacial Unit, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7LN, UK.
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Xu YS, Zheng JY, Zhang S, Fan DS. Upper trapezius electromyography aids in the early diagnosis of bulbar involvement in amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2011; 12:345-8. [DOI: 10.3109/17482968.2011.582647] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bradley PJ, Ferlito A, Silver CE, Takes RP, Woolgar JA, Strojan P, Suárez C, Coskun H, Zbären P, Rinaldo A. Neck treatment and shoulder morbidity: Still a challenge. Head Neck 2010; 33:1060-7. [DOI: 10.1002/hed.21495] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 04/14/2010] [Accepted: 04/22/2010] [Indexed: 11/06/2022] Open
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Hinsley ML, Hartig GK. Anatomic relationship between the spinal accessory nerve and internal jugular vein in the upper neck. Otolaryngol Head Neck Surg 2010; 143:239-41. [PMID: 20647127 DOI: 10.1016/j.otohns.2010.03.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 03/17/2010] [Accepted: 03/31/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The goal of this study was to precisely detail the relationship between the spinal accessory nerve (SAN) and the internal jugular vein (IJV) in the upper neck, specifically at the level of the posterior belly of the digastric muscle. STUDY DESIGN Case series with planned data collection. SETTING University hospital. SUBJECTS AND METHODS This information was prospectively gathered intraoperatively in patients undergoing a neck dissection. The neck dissections were performed for the treatment or diagnosis of cancer, independent of the research goals. Eighty-six subjects underwent neck dissections, 56 unilateral and 30 bilateral. The position of the SAN was determined to be oriented lateral to the IJV, medial to the IJV, posterior to the IJV, or directly through the IJV at the level of the posterior belly of the digastric muscle. RESULTS Of 116 neck dissections, 112 (96%) were oriented lateral to the IJV at the level of the superior border of the posterior belly of the digastric muscle. In three necks (3%), the SAN was positioned medial to the IJV, and one (1%) traveled directly through the IJV. CONCLUSION The SAN has an intimate anatomic relationship with the IJV as it travels through the neck. The SAN is nearly always oriented lateral to the IJV, and the IJV and SAN are likely at some increased risk of injury during neck dissection in cases where the nerve travels medial to or through the IJV.
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Affiliation(s)
- Matthew L Hinsley
- Department of Otolaryngology-Head and Neck Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
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Carr SD, Bowyer D, Cox G. Upper limb dysfunction following selective neck dissection: A retrospective questionnaire study. Head Neck 2009; 31:789-92. [DOI: 10.1002/hed.21018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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The skin-sternocleidomastoid muscle composite flap for neck dissection (the gator neck flap). Laryngoscope 2008; 118:1791-2. [PMID: 18622318 DOI: 10.1097/mlg.0b013e31817d23f0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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