IATROGENIC ACCESSORY NERVE INJURY

Accessory nerve injury produces considerable disability. The nerve is most frequently damaged as a complication of radical neck dissection, cervical lymph node biopsy and other surgical procedures, The problem is frequently compounded by a failure to recognise the error immediate ly after surgery when surgical repair has the greatest chance of succe ss We present cases which outline the risk of accessory nerve injury, the spectrum of clinical presentations and the problems produced by a failure to recognise the deficit. Regional anatomy, consequences of ne rve damage and management options are discussed. Diagnostic biopsy of neck nodes should not be undertaken as a primary investigation and, wh en indicated, surgery in this region should be performed by suitably t rained staff under well-defined conditions. Awareness of iatrogenic in jury and its consequences would avoid delays in diagnosis and treatmen t.