Abstract
Head and neck cancers are fairly common in India due to the widespread consumption of tobacco and neck dissection is a major component in the surgical management. The objective of this study is to analyze the effect of MRND and SND on shoulder function and quality of life in patients of head and neck cancer. Our study is a prospective comparative study on 65 head and neck cancer patients divided into 2 groups—33 in group A (MRND group) and 32 in group B (SND group). Clinical evaluation of shoulder function was done pre-operatively, 1 week, 1 month, 3 month and 6 month post-operatively using arm abduction scores (AAS) and shoulder pain and disability index (SPADI). Nerve-conduction study (NCS) was done pre-operatively and 3 months post-operatively for assessment of SAN. Neck dissection quality of life questionnaire (NDQOL) was used as a quality-of-life measure. A total of 65 neck dissections were included in the analysis (33 in group A and 32 in group B) out of which 53 were males and 12 were females. The mean AAS on the 6th post-operative month in group A was significantly lower than that of group B (p = 0.01). The mean SPADI scores on the 6th post-operative month was significantly worse in group A than group B (p value 0.01). On NCS, a significant decrease in amplitude was seen in group A (p = 0.02) and a significant increase in latency was noted in group B (p = 0.005). Quality of life score on 6th post-operative month showed no significant difference between both the groups (p > 0.05). Level V dissection in MRND is associated with higher incidence and greater severity of shoulder dysfunction. AAS and SPADI score are useful tools in post operative follow up of shoulder dysfunction. NCS helps in the detection of neuropathy and to determine its severity. Early rehabilitation promotes long term recovery.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Asthana S, Patil RS, Labani S (2016) Tobacco-related cancers in India: A review of incidence reported from population-based cancer registries. Indian J Med Paediatr Oncol 37(3):152–157
Dandekar M, Tuljapurkar V, Dhar H, Panwar A, DCruz AK (2017) Head and neck cancers in India. J Surg Oncol 115(5):555–63
Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, Gershenwald JE (2018) AJCC cancer staging form supplement. Ajcc cancer staging manual, 8th edn. Springer, Berlin, pp 303–10
Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A et al (2002) Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of otolaryngology-head and neck surgery. Arch Otolaryngol Head Neck Surg 128(7):751–758
Ewing MR, Martin H (1952) Disability following “radical neck dissection” An assessment based on the postoperative evaluation of 100 patients. Cancer 5:873
Cheng A, Schmidt BL (2008) Management of the N0 neck in oral squamous cell carcinoma. Oral Maxillof Surg Clin North Am. https://doi.org/10.1016/j.coms.2008.02.002
Bradley PJ, Ferlito A, Silver CE, Takes RP, Woolgar JA, Strojan P et al (2011) Neck treatment and shoulder morbidity: still a challenge. Head and Neck. https://doi.org/10.1002/hed.21495
Giordano L, Sarandria D, Fabiano B, Bussi M, Del Carro U (2012) Shoulder function after selective and superselective neck dissections: clinical and functional outcomes. Acta Otorhinolaryngol Ital 32(6):376–379
Rhoton ALJ, Buza R (1975) Microsurgical anatomy of the jugular foramen. J Neurosurg 42(5):541–550
Soo KC, Hamlyn PJ, Pegington J, Westbury G (1986) Anatomy of the accessory nerve and its cervical contributions in the neck. Head Neck Surg 9(2):111–115
Lloyd S (2007) Accessory nerve: anatomy and surgical identification. J Laryngol Otol 121(12):1118–1125
Popovski V, Benedetti A, Popovic-Monevska D, Grcev A, Stamatoski A, Zhivadinovik J (2017) Preservazione del nervo accessorio spinale nelle dissezioni del collo: Outcomes chirurgici e funzionali. Acta Otorhinolaryngol Ital 37(5):368–374
Giordano L, Sarandria D, Fabiano B, Del Carro U, Bussi M (2012) Shoulder function after selective and superselective neck dissections: clinical and functional outcomes. Acta Otorhinolaryngol Ital. 32(6):376–9
Imai T, Sato Y, Abe J, Kumagai J, Morita S, Saijo S et al (2021) Shoulder function after neck dissection: assessment via a shoulder-specific quality-of-life questionnaire and active shoulder abduction. Auris Nasus Larynx 48(1):138–47. https://doi.org/10.1016/j.anl.2020.06.013
Cappiello J, Piazza C, Giudice M, De Maria G, Nicolai P (2005) Shoulder disability after different selective neck dissections (levels II–IV versus levels II–V): a comparative study. Laryngoscope 115(2):259–263
Breckenridge JD, McAuley JH (2011) Shoulder pain and disability index (SPADI). J Physiother 57(3):197. https://doi.org/10.1016/S1836-9553(11)70045-5
Chaplin JM, Morton RP (1999) A prospective, longitudinal study of pain in head and neck cancer patients. Head Neck 21(6):531–537
Tavee J (2019) Nerve conduction studies: basic concepts. In: Levin KH, Chauvel P (eds) Clinical neurophysiology: basis and technical aspects, 1st edn. Elsevier, Amsterdam, pp 217–224. https://doi.org/10.1016/B978-0-444-64032-1.00014-X
Chaudhry V, Cornblath DR (1992) Wallerian degeneration in human nerves: serial electrophysiological studies. Muscle Nerve 15(6):687–693
Dimachkie MM, Barohn RJ (2013) Chronic inflammatory demyelinating polyneuropathy. Curr Treat Options Neurol 15(3):350–366
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendices
Appendix 1
Arm abduction score
Abduction angle | Score |
|---|---|
• Can raise up to 180° without pain/effort | 5 |
• Can raise up to 180° with pain/effort | 4 |
• Can raise up to > 150° but < 180° | 3 |
• Can raise up to > 90° but < 150° | 2 |
• Can raise up to < 90° | 1 |
Shoulder Pain and Disability Index (SPADI)
Please place a mark on the line that best represents your experience during the last week attributable to your shoulder problem.
Pain Scale
How Severe is your Pain?
Circle the number that best describes your pain where: 0 = no pain and 10 = the worst pain imaginable.
At its worst? | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
When lying on the involved side: | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Reaching for something on a high shelf? | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Touching the back of your neck? | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Pushing with invoved arm? | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Disability Scale
How Much Difficulity do you Have?
Circle the number that best describes your pain where: 0 = no pain and 10 = so difficulty it requires help.
Washing your hair? | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Washing your back? | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Putting on an undershirt or jumper? | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Putting on a shirt that button down the front? | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Putting on your pants? | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Placing an object on the high shelf? | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Carrying a heavy object of 10 pounds (4.5 km) | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Removing something from your back pocket | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
Neck Dissection Quality of Life Questionnaire (NDQOL)
Questions | Score |
|---|---|
• Are you bothered by neck or shoulder stiffness? | 1–5 |
• Are you bothered by tightness in your neck? | 1–5 |
• Are you bothered by pain in neck or shoulder? | 1–5 |
• Are you bothered by numbness of your neck? | 1–5 |
• Do you think your shoulder is dropped? | 1–5 |
• Have you been limited in your ability to reach above for objects because of your shoulder or neck? | 1–5 |
• Are you bothered by the appearance of your neck? | 1–5 |
• Total score | 7–35 |
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Mishra, A.K., Parida, P.K., Bhoi, S.K. et al. Shoulder Dysfunction and Quality of Life Following Modified Radical and Selective Neck Dissection: A Prospective Comparative Study. Indian J Otolaryngol Head Neck Surg (2024). https://doi.org/10.1007/s12070-024-04659-y
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s12070-024-04659-y