Impact of Superior and Inferior Approach in Identification and Preservation of Spinal Accessory Nerve during Modified Radical Neck Dissection in Patients with Oral Squamous Cell Carcinoma

Abstract

Background: During neck dissection, injuries to spinal accessory nerve (SAN) are most common cause of post-operative shoulder morbidity. Which is known as ‘Shoulder Syndrome’. Despite the evolution in neck dissection procedures from radical to super-selective neck dissection, post-operative shoulder dysfunction remains a point of exasperation for head and neck surgeons. It significantly impacts the standard of living for patients with head and neck cancer. According to the anatomic course and branching of SAN, there are various dissection technique for identification and preservation. Our comparison of superior dissection approach with inferior dissection approach for identification, preservation, and complete skeletonization of SAN in posterior neck dissection has not been studied based on its anatomical course. Objective: To compare Superior Vs. Inferior approach group in regards to safety and superiority of the approach for SAN preservation with minimal or no intraoperative and or post-operative functional complications. Methods: The patients will be randomly divided into two groups according to the approach used to identify and preserve SAN (superior Vs. inferior approach group). The intraoperative clinical and post-operative data will be collected and evaluated with appropriate statistical analysis. Results: Collected data from 24 patients will undergo statistical analysis to obtain the results. Conclusion: This study expects to find a superior modality amongst the Superior dissection approach and inferior dissection approach in terms of identification, preservation, and post-operative functional deficit for spinal accessory nerve.