CABLE GRAFTING OF THE SPINAL ACCESSORY NERVE AFTER RADICAL NECK DISSECTION

Background: From January 1981 through March 1996, 20 patients with hea d and neck cancer underwent radical neck dissection with sacrifice of the spinal accessory nerve and immediate reconstruction of the nerve u sing a microsurgical technique and a cable graft of the great auricula r nerve. Methods: Postoperative shoulder function was assessed via a s ubjective questionnaire, objective strength testing, and/or postoperat ive electromyography. The latter was used to evaluate for the presence and amplitude of voluntary motor potentials, the presence of fibrilla tion potentials, and nerve conduction latency. The group of patients w ho underwent cable grafting of the spinal accessory nerve was compared with a group of patients who underwent modified radical neck dissecti on with preservation of the spinal accessory nerve and with another gr oup of patients who underwent a classic neck dissection with sacrifice of the spinal accessory nerve and no reconstruction. Results: In term s of shoulder function, the group of patients in whom the spinal acces sory nerve was reconstructed occupied an intermediate position; ie, th eir postoperative shoulder function was better than that of the patien ts who underwent radical neck dissection without reconstruction but no t as good as that of the patients who underwent modified neck dissecti on with preservation of the spinal accessory nerve. Conclusion: Cable grafting of the spinal accessory nerve that has been sacrificed during radical neck dissection results in improved shoulder function in the postoperative period.