Marginal Mandibular Nerve Palsy Incidence in Neck Dissection

Abstract

Objective: The marginal mandibular nerve (MMN), a branch of the facial nerve, is at risk of damage during neck dissections. The resulting asymmetry of the mouth can cause distress as well as physical problems (dental lip trauma and fluid spillage) and is often not appreciated preoperatively. The authors wished to: 1) ascertain the incidence of marginal mandibular nerve (MMN) palsy during neck dissections, and 2) correlate risk of nerve palsy with level of nodal clearance. Method: All neck dissections undertaken at a tertiary referral head and neck oncology center from the last 2 years 1/1/10-1/1/12 were examined. Data collected include type of neck dissection, levels cleared, and pre- and postoperative MMN function. Results: We collected data from 50 consecutive neck dissections. Seven of 50 (14%) patients had an MMN palsy postoperatively. Of these 100% were permanent. As expected, patients with level 1 clearance were those at highest risk of MMN palsy. The grade of the operating surgeon was not statistically significant. Conclusion: The incidence of MMN palsy in neck dissections is high. Despite being a recognized complication of neck dissection surgery, there are limited data regarding rates of MMN palsy or correlation with levels of nodal clearance. The authors suggest that preoperatively the patient should be alerted to the incidence of MMN plasy, especially if level I is to be included in the dissection.