Shoulder Dysfunction after Neck Dissection in Patients with Head and Neck Cancer: A Tertiary Care Experience.

BACKGROUND: Head and neck cancer is the 6th most common cancer worldwide. Neck dissection is performed in patients with head and neck cancer to remove lymph nodes harboring cancer cells. Accessory nerve travels through the neck and is encountered during neck dissection. Damage to this nerve causes shoulder dysfunction. Shoulder dysfunction after neck dissection has been reported in studies. Head and Neck cancer surgery is a common procedure that we are performing at our institute, and it is very common of patients to complain of shoulder pain after neck dissections. We did this study to find out how significant the problem of shoulder dysfunction is in our patients after neck dissections so that necessary steps can be taken to overcome this problem. OBJECTIVES: To describe the changes in shoulder function scores after neck dissections at 12 weeks and 24 weeks. To see the association of different types of neck dissections with shoulder dysfunction. METHODS: This was a prospective cohort study conducted at section of Otorhinolaryngology and Head and Neck Surgery, Department of Surgery, Aga Khan University Hospital with a sample size of 19. Our primary outcome was shoulder dysfunction. This was measured using the Constant Murley Shoulder Score. The score was assessed at baseline and 12 weeks post operatively. The mean baseline scores were compared to those at 12 weeks. One observer assessed all the patients for the score to eliminate inter observer variation. Data analysis was done using SPSS 19. Wilcoxon signed rank test was applied to compare the median scores at baseline and 12 weeks. Mann-Whitney test was applied to compare shoulder dysfunction in different types of neck dissections. RESULTS: We had a sample size of 19. Median age was 52 years. 12 patients were male and 7 patients were female. There were 8 modified radical neck dissections and 11 selective neck dissections. Median Constant score at baseline was 96 with interquartile range of 3. Median Constant score at 12 weeks was 78 with interquartile range of 19.This was statistically significant with p-value of 0.00There was significantly more dysfunction in patients with modified radical neck dissection as compared to selective neck dissections and this was also statistically significant. CONCLUSION: This shows that there is a significant shoulder dysfunction at 12 weeks after neck dissections There was less shoulder dysfunction in patients undergoing selective neck dissections. [ABSTRACT FROM AUTHOR]