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. 2015 Sep 4;3(9):e504.
doi: 10.1097/GOX.0000000000000457. eCollection 2015 Sep.

Preventable Sternocleidomastoid Muscular Atrophy after Neck Dissection

Nao Yamamoto  1 , Natsuko Yoshimura Sawai  1 , Shunsuke Ishimoto  1 , Hide Ogura  1 , Tomonao Aikawa  1 , Mikihiko Kogo  1 , Masaya Okura  1
Affiliations

Preventable Sternocleidomastoid Muscular Atrophy after Neck Dissection

Nao Yamamoto et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Modified radical neck dissection (mRND) [preserving the sternocleidomastoid muscle (SCM) and the spinal accessory nerve] and supraomohyoid neck dissection have become common surgical procedures for treating head and neck cancer. Postoperative severe asymmetry of the neck and severe atrophy of the SCM, however, have been demonstrated.

Methods: Using computed tomographic images, cross-sectional areas of the SCMs were measured in 99 patients with carcinoma of the oral cavity who underwent unilateral mRND or supraomohyoid neck dissection. An asymmetry index was used.

Results: Innervation to the SCM was preserved in 91 patients. The spinal accessory nerve and the innervation were sacrificed in 3 patients; the innervation was repaired in 5 patients. Sacrifice of innervation to the SCM resulted in extremely severe asymmetry. Repair of the innervation prevented severe asymmetry in 40%. Preservation of the innervation prevented severe asymmetry in 75% at the middle portion of the neck and in 56% at the lower portion after mRND.

Conclusion: Preserving innervation to the SCM and gentle handling of the nerve during neck dissection could prevent severe asymmetry after neck dissection.

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Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by a grant from the Japan Society for the Promotion of Science, Sports and Culture (#24593027 to MO).

Figures

Fig. 1.
Fig. 1.
Patients with cancers of the oral cavity. A, A 62-year-old man with T2N1M0 tongue cancer at 3 years after left supraomohyoid neck dissection. These CT images above were obtained 17 months after neck dissection. B, A 75-year-old man with T2N2bM0 with cancer of buccal mucosa at 6 years after left modified radical neck dissection. These CT images below were obtained 18 months after the treatment. C and D, CT images at the level of the hyoid bone. C, The CSAc (right SCM) was 2.38 mm2, CSAa (left SCM) was 1.90 mm2, and AI-H was 22.4%. D, The CSAc (right SCM) was 3.55 mm2, CSAa was 3.12 mm2, and AI-H was 12.9%. E and F, CT images at the level of the cricoid cartilage. E, CSAc was 2.59 mm2, CSAa was 1.86 mm2, and AI-C was 32.8%. F, CSAc was 3.30 mm2, CSAa was 2.63 mm2, and AI-C was 22.6%.
Fig. 2.
Fig. 2.
A, A 68-year-old man with rT4aN1M0 tongue cancer 6 years after left modified radical neck dissection with postoperative radiotherapy. The spinal accessory nerve was sacrificed. The CT images were obtained 34 months after treatment. B, CT image at the level of the hyoid bone; CSAc was 2.62 mm2, CSAa was 0.79, and AI-H was 107.3%. C, CT image at the level of the cricoid cartilage; CSAc was 2.98 mm2, CSAa was 0.53 mm2, and AI-C was 139.5%.
Fig. 3.
Fig. 3.
Box plots of the pre-AI-H and pre-AI-C distributions and the post-AI-H and post-AI-C distributions according to the condition of the SCM innervation.
Fig. 4.
Fig. 4.
Box plots of the AI-H and AI-C distributions according to the type of neck dissection.
Fig. 5.
Fig. 5.
Box plots of the AI-H and AI-C distributions according to radiotherapy to the neck.
See this image and copyright information in PMC

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