Open functional neck dissection: surgical efficacy and electrophysiologic status of the neck and accessory nerve.

Abstract

To compare a novel functional neck dissection technique that offers wider exposure and reduced morbidity compared to classic functional neck dissection, which is the gold standard for neck treatment of squamous cell carcinoma of the head and neck. A prospective, double-blind, controlled clinical study. Fifty surgical neck dissections were performed on 25 patients diagnosed with laryngeal cancer. SUBJECTS AND METHODS (MAIN OUTCOME MEASURES): The open neck dissection technique was used on the primary tumour side (study group) and functional neck dissection was used on the other side (control group). Electromyographic measurements of the trapezius and sternocleidomastoid muscles and neurologic evaluations were performed preoperatively and at 1 and 6 months postoperatively. Also, the number and tumour stages of lymph nodes excised during neck dissection were evaluated by histopathologic examination as a measure of surgical efficacy. The electromyographic measurements of the study group at 1 and 6 months postoperatively were found to be superior to those of the control group, although the difference between the groups was not significant. The mean number of dissected lymph nodes was significantly higher in the study group than in the control group. The open functional neck dissection procedure described in this study allows wider exposure, reduces the acute morbidity associated with the spinal accessory nerve compared to classic modified neck dissection, and offers improved surgical efficacy with respect to lymphadenectomy.