Neurovascular Complications After Neck Dissection: a Prospective Analysis at a Tertiary Care Centre in South India
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ORIGINAL ARTICLE
Neurovascular Complications After Neck Dissection: a Prospective Analysis at a Tertiary Care Centre in South India Nivedita Sharma 1,2 & Nebu Abraham George 1 & Paul Sebastian 1 Received: 30 April 2020 / Accepted: 15 September 2020 # Indian Association of Surgical Oncology 2020
Abstract Owing to high incidence of oral cancers in India, neck dissection is the most commonly performed procedure in any head and neck oncology setup. This surgery is particularly prone to various neurovascular complications due to intricate anatomy of neck, but the exact incidence has been studied less especially in Indian subcontinent. A prospective observational study was done on 105 patients of oral cancer who underwent neck dissection at Regional Cancer Centre, Trivandrum, and various short-term and long-term neurovascular complications were recorded. There was high temporary praxia of marginal mandibular and greater auricular nerve of 32.5% and 36.1%, respectively, immediate post-operative period which reduced significantly during 6 months. Eight patients had long-term shoulder abduction difficulty. There were isolated cases of IJV thrombosis and phrenic nerve paralysis. Despite our best intentions, complications arise due to complex anatomy of the neck, but if surgeon remains cognisant of the potential complications, their impact on patients’ health, pocket and hospital resources can be minimized. Keywords Neck dissection . Oral cancers . Shoulder dysfunction
Introduction The history of neck dissection reveals a continuing quest to reduce its complications and sequelae. Since its original description by Crile in 1906 and subsequent popularization by Hays Martin in 1951, the radical neck dissection (RND) remained the standard treatment for palpable or potential cervical metastasis in head and neck cancers. Though it provided a reliable method of treating patients with head and neck cancer, it became increasingly apparent that it carried substantial morbidity, which led to development of modified procedures that attempted to reduce the adverse effects of the classical operation and yet preserve its effectiveness in oncological terms [1, 2]. As neck dissection surgical techniques have evolved, so have the type and frequency of complications. Due to intricate
* Nivedita Sharma [email protected] 1
Department of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
2
Present address: Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India
anatomy and presence of various nerves, vessels and lymphatic channels, neck dissections are particularly prone to various neurovascular complications. Shoulder complaints and functional impairment are common sequel of neck dissection, often attributed to injury of the spinal accessory nerve by dissection or direct trauma. Although current modifications in neck dissection aim at preserving the spinal accessory nerve, a variable degree of shoulder dysfunction still occurs in a significant number of patients. Thes
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