Sensory preservation in neck dissection: outcomes of a sub-sternocleidomastoid approach

Abstract

Objective: Cutaneous anesthesia in early postoperative period is common after neck dissection even if the cervical nerve (CN) rootlets are preserved. The aim of this study was to evaluate if the preservation of the terminal branches of CNs using sub-sternocleidomastoid (SCM) approach combined with medially placed skin incision can prevent early postoperative anesthesia.

Material and methods: A retrospective chart review was performed on 129 neck dissections in 87 head and neck cancer patients.

Results: The early postoperative sensory preservation rates for the ear tab, submandibular, lateral neck, and sub-clavicular areas of CN rootlet-preserved necks (n = 86) were 75.6%, 20.9%, 74.4%, and 86.0%, respectively, compared with 37.2%, 2.3%, 2.3%, and 4.7%, respectively, in CN rootlet-resected necks (n = 43). In CN rootlet-preserved necks, the sub-SCM approach (n = 54) showed 81.5%, 27.8%, 92.6%, and 94.4% preservation rates, respectively, compared with 65.6%, 9.4%, 43.8%, and 71.9%, respectively, using the conventional subplatysmal approach (n = 32). The rates were significantly better in the submandibular, lateral neck, and sub-clavicular areas after sub-SCM approach.

Conclusions: Preservation of CN rootlets is a required element for sensory preservation in neck dissection. The sub-SCM approach can effectively prevent early postoperative cutaneous anesthesia following CN-preserving neck dissection.

Chinese abstract

目的：颈部解剖之后, 即使保留了颈神经（CN）小根, 术后早期皮肤麻木仍然常见。这项研究的目的是评估使用亚胸锁乳突肌（SCM）方法结合内侧置皮肤切口来保留CN末端分支是否可以预防早期术后麻木。

材料和方法：对87名头颈部癌症患者的129次颈部解剖进行回顾性分析。

结果：保留了颈神经小根的脖子（n = 86）的耳塞、颌下、侧颈和锁骨下区的早期术后感觉的保留率分别为75.6%、20.9%、74.4%和86.0%, 而对于颈神经小根切除的脖子（n = 43）, 保留率分别为37.2%、2.3%、2.3%和4.7%。在保留颈神经小根的颈脖中, 亚SCM方法（n = 54）显示81.5%、27.8%、92.6%和94.4%的保存率, 传统的亚层流方式（n = 32）显示分别为65.6%、9.4%、43.8%和71.9%的保存率 。亚SCM方法之后, 下颌下、侧颈和锁骨下区的保存率明显更好。

结论：保留颈神经小根是颈部手术时保留感觉的必要因素。采用亚SCM方法可以有效预防保留颈神经的颈部手术后的早期术后皮肤麻木。

Keywords:

• Sensory outcome
• neck dissection
• preservation
• cervical nerve
• sub-sternocleidomastoid approach

Disclosure statement

No potential conflict of interest was reported by the authors.