EXTRACRANIAL SPINAL ACCESSORY NERVE INJURY

EIGHTY-THREE CONSECUTIVE PATIENTS with extracranial accessory nerve in jury seen over a 12-year period are reviewed. The most common etiology was iatrogenic injury to the nerve at the time of previous surgery. S uch operations were usually minor in nature and often related to lymph node or benign tumor removal. Examination usually distinguished wingi ng due to trapezius weakness from that of serratus anterior palsy. Tra pezius weakness was seen in all cases. Sternocleidomastoid weakness wa s unusual. Patients with accessory palsy were evaluated by both clinic al and electromyographic studies. Patients who exhibited no clinical o r electrical evidence of regeneration were operated on (44 cases). Bas ed on intraoperative nerve action potential studies, 8 lesions in cont inuity had neurolysis alone. Resection with repair either by end-to-en d suture or by grafts was necessary in 31 cases. One case had suture r emoved from nerve, two had nerve placed into target muscle, and two ha d more proximal neurotization. Function was usually improved in both o perative and nonoperative patients. Related anatomy is discussed.