Shoulder Disability After Different Selective Neck Dissections (Levels II-IV Versus Levels II-V): A Comparative Study

Objectives/Hypothesis: The objective was to compare the results of clinical and electrophysiological investigations of shoulder function in patients affected by head and neck carcinoma treated with concomitant surgery on the primary and the neck with different selective neck dissections. Study Desig...

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Veröffentlicht in:The Laryngoscope 2005-02, Vol.115 (2), p.259-263
Hauptverfasser: Cappiello, Johnny, Piazza, Cesare, Giudice, Marco, De Maria, Giovanni, Nicolai, Piero
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description Objectives/Hypothesis: The objective was to compare the results of clinical and electrophysiological investigations of shoulder function in patients affected by head and neck carcinoma treated with concomitant surgery on the primary and the neck with different selective neck dissections. Study Design: Retrospective study of 40 patients managed at the Department of Otolaryngology, University of Brescia (Brescia, Italy) between January 1999 and December 2001. Methods: Two groups of 20 patients each matched for gender and age were selected according to the type of neck dissection received: patients in group A had selective neck dissection involving clearance of levels II–IV, and patients in group B had clearance of levels II–V. The inclusion criteria were as follows: no preoperative signs of myopathy or neuropathy, no postoperative radiotherapy, and absence of locoregional recurrence. At least 1 year after surgery, patients underwent evaluation of shoulder function by means of a questionnaire, clinical inspection, strength and motion tests, electromyography of the upper trapezius and sternocleidomastoid muscles, and electroneurography of the spinal accessory nerve. Statistical comparisons of the clinical data were obtained using the contingency tables with Fisher's Exact test. Electrophysiological data were analyzed by means of Fisher's Exact test, and electromyography results by Kruskal‐Wallis test. Results: A slight strength impairment of the upper limb, slight motor deficit of the shoulder, and shoulder pain were observed in 0%, 5%, and 15% of patients in group A and in 20%, 15%, and 15% of patients in group B, respectively. On inspection, in group B, shoulder droop, shoulder protraction, and scapular flaring were present in 30%, 15%, and 5% of patients, respectively. One patient (5%) in group A showed shoulder droop as the only significant finding. In group B, muscle strength and arm movement impairment were found in 25% of patients, 25% showed limited shoulder flexion, and 50% had abnormalities of shoulder abduction with contralateral head rotation. In contrast, only one patient (5%) in group A presented slight arm abduction impairment. Electromyographic abnormalities were less frequently found in group A than in group B (40% vs. 85% [P = .003]), and the distribution of abnormalities recorded in the upper trapezius muscle and sternocleidomastoid muscle was quite different: 20% and 40% in group A versus 85% and 45% in group B, respectively. Only one case
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Study Design: Retrospective study of 40 patients managed at the Department of Otolaryngology, University of Brescia (Brescia, Italy) between January 1999 and December 2001. Methods: Two groups of 20 patients each matched for gender and age were selected according to the type of neck dissection received: patients in group A had selective neck dissection involving clearance of levels II–IV, and patients in group B had clearance of levels II–V. The inclusion criteria were as follows: no preoperative signs of myopathy or neuropathy, no postoperative radiotherapy, and absence of locoregional recurrence. At least 1 year after surgery, patients underwent evaluation of shoulder function by means of a questionnaire, clinical inspection, strength and motion tests, electromyography of the upper trapezius and sternocleidomastoid muscles, and electroneurography of the spinal accessory nerve. Statistical comparisons of the clinical data were obtained using the contingency tables with Fisher's Exact test. Electrophysiological data were analyzed by means of Fisher's Exact test, and electromyography results by Kruskal‐Wallis test. Results: A slight strength impairment of the upper limb, slight motor deficit of the shoulder, and shoulder pain were observed in 0%, 5%, and 15% of patients in group A and in 20%, 15%, and 15% of patients in group B, respectively. On inspection, in group B, shoulder droop, shoulder protraction, and scapular flaring were present in 30%, 15%, and 5% of patients, respectively. One patient (5%) in group A showed shoulder droop as the only significant finding. In group B, muscle strength and arm movement impairment were found in 25% of patients, 25% showed limited shoulder flexion, and 50% had abnormalities of shoulder abduction with contralateral head rotation. In contrast, only one patient (5%) in group A presented slight arm abduction impairment. Electromyographic abnormalities were less frequently found in group A than in group B (40% vs. 85% [P = .003]), and the distribution of abnormalities recorded in the upper trapezius muscle and sternocleidomastoid muscle was quite different: 20% and 40% in group A versus 85% and 45% in group B, respectively. Only one case of total upper trapezius muscle denervation was observed in group B. In both groups, electroneurographic data from the side of the neck treated showed a statistically significant increase in latency (P = .001) and decrease in amplitude (P = .008) compared with the contralateral side. There was no significant difference in electroneurographic data from the side with and the side without dissection in either group. Even though a high number of abnormalities was found on electrophysiological testing, only a limited number of patients, mostly in group B, displayed shoulder function disability affecting daily activities. Conclusion: The study data confirm that clearance of the posterior triangle of the neck increases shoulder morbidity. However, subclinical nerve impairment can be observed even after selective neck dissection (levels II–IV) if the submuscular recess is routinely dissected.</description><identifier>ISSN: 0023-852X</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1097/01.mlg.0000154729.31281.da</identifier><identifier>PMID: 15689746</identifier><identifier>CODEN: LARYA8</identifier><language>eng</language><publisher>Hoboken, NJ: John Wiley &amp; Sons, Inc</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Electromyography ; electroneurography ; Female ; Humans ; Laryngeal Neoplasms - surgery ; Male ; Medical sciences ; Middle Aged ; Muscle, Skeletal - physiopathology ; Neck Dissection - adverse effects ; Neck Dissection - methods ; Neural Conduction ; Oropharyngeal Neoplasms - surgery ; Otorhinolaryngology. Stomatology ; Retrospective Studies ; Selective neck dissection ; Shoulder - physiopathology ; shoulder function ; Shoulder Joint - physiopathology ; Shoulder Pain - etiology ; spinal accessory nerve</subject><ispartof>The Laryngoscope, 2005-02, Vol.115 (2), p.259-263</ispartof><rights>Copyright © 2005 The Triological Society</rights><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4482-ef863f0b8ab6eac8c20b1b18d46eebbb8e1927753e728dfabb1ec32f832428633</citedby><cites>FETCH-LOGICAL-c4482-ef863f0b8ab6eac8c20b1b18d46eebbb8e1927753e728dfabb1ec32f832428633</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1097%2F01.mlg.0000154729.31281.da$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1097%2F01.mlg.0000154729.31281.da$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=16530723$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15689746$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cappiello, Johnny</creatorcontrib><creatorcontrib>Piazza, Cesare</creatorcontrib><creatorcontrib>Giudice, Marco</creatorcontrib><creatorcontrib>De Maria, Giovanni</creatorcontrib><creatorcontrib>Nicolai, Piero</creatorcontrib><title>Shoulder Disability After Different Selective Neck Dissections (Levels II-IV Versus Levels II-V): A Comparative Study</title><title>The Laryngoscope</title><addtitle>The Laryngoscope</addtitle><description>Objectives/Hypothesis: The objective was to compare the results of clinical and electrophysiological investigations of shoulder function in patients affected by head and neck carcinoma treated with concomitant surgery on the primary and the neck with different selective neck dissections. Study Design: Retrospective study of 40 patients managed at the Department of Otolaryngology, University of Brescia (Brescia, Italy) between January 1999 and December 2001. Methods: Two groups of 20 patients each matched for gender and age were selected according to the type of neck dissection received: patients in group A had selective neck dissection involving clearance of levels II–IV, and patients in group B had clearance of levels II–V. The inclusion criteria were as follows: no preoperative signs of myopathy or neuropathy, no postoperative radiotherapy, and absence of locoregional recurrence. At least 1 year after surgery, patients underwent evaluation of shoulder function by means of a questionnaire, clinical inspection, strength and motion tests, electromyography of the upper trapezius and sternocleidomastoid muscles, and electroneurography of the spinal accessory nerve. Statistical comparisons of the clinical data were obtained using the contingency tables with Fisher's Exact test. Electrophysiological data were analyzed by means of Fisher's Exact test, and electromyography results by Kruskal‐Wallis test. Results: A slight strength impairment of the upper limb, slight motor deficit of the shoulder, and shoulder pain were observed in 0%, 5%, and 15% of patients in group A and in 20%, 15%, and 15% of patients in group B, respectively. On inspection, in group B, shoulder droop, shoulder protraction, and scapular flaring were present in 30%, 15%, and 5% of patients, respectively. One patient (5%) in group A showed shoulder droop as the only significant finding. In group B, muscle strength and arm movement impairment were found in 25% of patients, 25% showed limited shoulder flexion, and 50% had abnormalities of shoulder abduction with contralateral head rotation. In contrast, only one patient (5%) in group A presented slight arm abduction impairment. Electromyographic abnormalities were less frequently found in group A than in group B (40% vs. 85% [P = .003]), and the distribution of abnormalities recorded in the upper trapezius muscle and sternocleidomastoid muscle was quite different: 20% and 40% in group A versus 85% and 45% in group B, respectively. Only one case of total upper trapezius muscle denervation was observed in group B. In both groups, electroneurographic data from the side of the neck treated showed a statistically significant increase in latency (P = .001) and decrease in amplitude (P = .008) compared with the contralateral side. There was no significant difference in electroneurographic data from the side with and the side without dissection in either group. Even though a high number of abnormalities was found on electrophysiological testing, only a limited number of patients, mostly in group B, displayed shoulder function disability affecting daily activities. Conclusion: The study data confirm that clearance of the posterior triangle of the neck increases shoulder morbidity. However, subclinical nerve impairment can be observed even after selective neck dissection (levels II–IV) if the submuscular recess is routinely dissected.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Electromyography</subject><subject>electroneurography</subject><subject>Female</subject><subject>Humans</subject><subject>Laryngeal Neoplasms - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Muscle, Skeletal - physiopathology</subject><subject>Neck Dissection - adverse effects</subject><subject>Neck Dissection - methods</subject><subject>Neural Conduction</subject><subject>Oropharyngeal Neoplasms - surgery</subject><subject>Otorhinolaryngology. Stomatology</subject><subject>Retrospective Studies</subject><subject>Selective neck dissection</subject><subject>Shoulder - physiopathology</subject><subject>shoulder function</subject><subject>Shoulder Joint - physiopathology</subject><subject>Shoulder Pain - etiology</subject><subject>spinal accessory nerve</subject><issn>0023-852X</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkE-P0zAQxSMEYsvCV0AWEggOCf4Tx87eqkKXrqqCKBQ4WbYzhrBOU-xkod-epK3oGV9GHv3em5mXJM8IzgguxWtMssZ_z_DwCM8FLTNGqCRZpe8lE8IZSfOy5PeTCcaUpZLTrxfJoxh_DrhgHD9MLggvZCnyYpL06x9t7ysI6E0dtal93e3R1HWHhnMQYNuhNXiwXX0HaAX2diTj-G-3Eb1cwh34iBaLdLFBGwixj-jc27y6QlM0a5udDvrgsO76av84eeC0j_DkVC-Tz_O3n2bv0uX768VsukxtnkuagpMFc9hIbQrQVlqKDTFEVnkBYIyRQEoqBGcgqKycNoaAZdRJRnM6SNll8uLouwvtrx5ip5o6WvBeb6HtoypEjnFB6QBeHUEb2hgDOLULdaPDXhGsxtAVJmoIXZ1DV4fQVaUH8dPTlN40UJ2lp5QH4PkJ0NFq74Le2jqeuYIzLOi47vzI_a497P9jBbWcfvzGeU4Ix5SM56RHozp28OefkQ63w8lMcPVlda3mN_PVhn24UYL9Bd4ur60</recordid><startdate>200502</startdate><enddate>200502</enddate><creator>Cappiello, Johnny</creator><creator>Piazza, Cesare</creator><creator>Giudice, Marco</creator><creator>De Maria, Giovanni</creator><creator>Nicolai, Piero</creator><general>John Wiley &amp; Sons, Inc</general><general>Wiley-Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>8BM</scope></search><sort><creationdate>200502</creationdate><title>Shoulder Disability After Different Selective Neck Dissections (Levels II-IV Versus Levels II-V): A Comparative Study</title><author>Cappiello, Johnny ; Piazza, Cesare ; Giudice, Marco ; De Maria, Giovanni ; Nicolai, Piero</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4482-ef863f0b8ab6eac8c20b1b18d46eebbb8e1927753e728dfabb1ec32f832428633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Electromyography</topic><topic>electroneurography</topic><topic>Female</topic><topic>Humans</topic><topic>Laryngeal Neoplasms - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Muscle, Skeletal - physiopathology</topic><topic>Neck Dissection - adverse effects</topic><topic>Neck Dissection - methods</topic><topic>Neural Conduction</topic><topic>Oropharyngeal Neoplasms - surgery</topic><topic>Otorhinolaryngology. Stomatology</topic><topic>Retrospective Studies</topic><topic>Selective neck dissection</topic><topic>Shoulder - physiopathology</topic><topic>shoulder function</topic><topic>Shoulder Joint - physiopathology</topic><topic>Shoulder Pain - etiology</topic><topic>spinal accessory nerve</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cappiello, Johnny</creatorcontrib><creatorcontrib>Piazza, Cesare</creatorcontrib><creatorcontrib>Giudice, Marco</creatorcontrib><creatorcontrib>De Maria, Giovanni</creatorcontrib><creatorcontrib>Nicolai, Piero</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>ComDisDome</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cappiello, Johnny</au><au>Piazza, Cesare</au><au>Giudice, Marco</au><au>De Maria, Giovanni</au><au>Nicolai, Piero</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Shoulder Disability After Different Selective Neck Dissections (Levels II-IV Versus Levels II-V): A Comparative Study</atitle><jtitle>The Laryngoscope</jtitle><addtitle>The Laryngoscope</addtitle><date>2005-02</date><risdate>2005</risdate><volume>115</volume><issue>2</issue><spage>259</spage><epage>263</epage><pages>259-263</pages><issn>0023-852X</issn><eissn>1531-4995</eissn><coden>LARYA8</coden><abstract>Objectives/Hypothesis: The objective was to compare the results of clinical and electrophysiological investigations of shoulder function in patients affected by head and neck carcinoma treated with concomitant surgery on the primary and the neck with different selective neck dissections. Study Design: Retrospective study of 40 patients managed at the Department of Otolaryngology, University of Brescia (Brescia, Italy) between January 1999 and December 2001. Methods: Two groups of 20 patients each matched for gender and age were selected according to the type of neck dissection received: patients in group A had selective neck dissection involving clearance of levels II–IV, and patients in group B had clearance of levels II–V. The inclusion criteria were as follows: no preoperative signs of myopathy or neuropathy, no postoperative radiotherapy, and absence of locoregional recurrence. At least 1 year after surgery, patients underwent evaluation of shoulder function by means of a questionnaire, clinical inspection, strength and motion tests, electromyography of the upper trapezius and sternocleidomastoid muscles, and electroneurography of the spinal accessory nerve. Statistical comparisons of the clinical data were obtained using the contingency tables with Fisher's Exact test. Electrophysiological data were analyzed by means of Fisher's Exact test, and electromyography results by Kruskal‐Wallis test. Results: A slight strength impairment of the upper limb, slight motor deficit of the shoulder, and shoulder pain were observed in 0%, 5%, and 15% of patients in group A and in 20%, 15%, and 15% of patients in group B, respectively. On inspection, in group B, shoulder droop, shoulder protraction, and scapular flaring were present in 30%, 15%, and 5% of patients, respectively. One patient (5%) in group A showed shoulder droop as the only significant finding. In group B, muscle strength and arm movement impairment were found in 25% of patients, 25% showed limited shoulder flexion, and 50% had abnormalities of shoulder abduction with contralateral head rotation. In contrast, only one patient (5%) in group A presented slight arm abduction impairment. Electromyographic abnormalities were less frequently found in group A than in group B (40% vs. 85% [P = .003]), and the distribution of abnormalities recorded in the upper trapezius muscle and sternocleidomastoid muscle was quite different: 20% and 40% in group A versus 85% and 45% in group B, respectively. Only one case of total upper trapezius muscle denervation was observed in group B. In both groups, electroneurographic data from the side of the neck treated showed a statistically significant increase in latency (P = .001) and decrease in amplitude (P = .008) compared with the contralateral side. There was no significant difference in electroneurographic data from the side with and the side without dissection in either group. Even though a high number of abnormalities was found on electrophysiological testing, only a limited number of patients, mostly in group B, displayed shoulder function disability affecting daily activities. Conclusion: The study data confirm that clearance of the posterior triangle of the neck increases shoulder morbidity. However, subclinical nerve impairment can be observed even after selective neck dissection (levels II–IV) if the submuscular recess is routinely dissected.</abstract><cop>Hoboken, NJ</cop><pub>John Wiley &amp; Sons, Inc</pub><pmid>15689746</pmid><doi>10.1097/01.mlg.0000154729.31281.da</doi><tpages>5</tpages></addata></record>
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subjects Adult
Aged
Biological and medical sciences
Electromyography
electroneurography
Female
Humans
Laryngeal Neoplasms - surgery
Male
Medical sciences
Middle Aged
Muscle, Skeletal - physiopathology
Neck Dissection - adverse effects
Neck Dissection - methods
Neural Conduction
Oropharyngeal Neoplasms - surgery
Otorhinolaryngology. Stomatology
Retrospective Studies
Selective neck dissection
Shoulder - physiopathology
shoulder function
Shoulder Joint - physiopathology
Shoulder Pain - etiology
spinal accessory nerve
title Shoulder Disability After Different Selective Neck Dissections (Levels II-IV Versus Levels II-V): A Comparative Study
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