SPINAL ACCESSORY NERVE PALSY - AN UNUSUAL COMPLICATION OF RHYTIDECTOMY

Rhytidectomy is a safe and effective procedure for rejuvenation of the aging face. Reported complication rates vary between 2.5% and 28%, an d with proper management, long-term sequelae are unusual. Injury to th e spinal accessory nerve is a rare but potentially debilitating compli cation of rhytidectomy. Afflicted patients present with dull, constant pain in the shoulder region which can be severe in nature. In additio n, there is weakness of shoulder abduction and cosmetic deformity rela ted to trapezius atrophy. Measures tor conservative management include analgesics and physical therapy to strengthen the shoulder girdle. Ne rve exploration is indicated for cases with documented denervation tha t do not respond to conservative treatment. A review of the English li terature identified two previous case reports of spinal accessory nerv e injury sustained during rhytidectomy. In this report, we present two additional cases and review current concepts regarding diagnosis, man agement, and prevention of this unusual complication of rhytidectomy.