Iatrogenic accessory nerve lesion after cervical lymph node biopsy

The majority of lesions of the spinal accessory nerve occur as an iatrogeni c injury after lymph node biopsy in the posterior cervical triangle (trigon um colli laterale). In most cases the accessory nerve palsy is not recognis ed immediately after the injury. Therefore surgical repair is often perform ed too late to regain sufficient function of the paralytic trapezius muscle . Later than 6 months after the injury, reconstruction seems to be hopeless ; However, "timely" reconstructions Often have poor results. Exact knowledg e of anatomy, postoperative check of the trapezius muscle and, if an access ory nerve injury has occurred, early reconstructive procedures (neurolysis, reconstruction of nerve continuity) may on the one hand prevent iatrogenic lesions of the nerve and on the other hand improve the reconstructive resu lt. A series of 6 patients with an injury of the spinal accessory nerve aft er lymph node biopsy is reported. In 2 cases primary coaptation, in 3 cases interpositional nerve grafting and in 1 case neurotisation was performed. Clinical recovery was achieved in 3 of the 6 cases.