European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 5, pp 1227–1234 | Cite as

Inspiratory muscle weakness, diaphragm immobility and diaphragm atrophy after neck dissection

  • Anne Flavia Silva Galindo Santana
  • Pedro Caruso
  • Pauliane Vieira Santana
  • Gislaine Cristina Lopes Machado Porto
  • Luiz Paulo Kowalski
  • Jose Guilherme Vartanian
Head and Neck



Inspiratory strength after a neck dissection has not been evaluated, and diaphragm function has not been adequately evaluated.


Evaluate diaphragm mobility and inspiratory strength after neck dissection.


Prospective data collection of a consecutive series of adult patients submitted to neck dissection for head and neck cancer treatment, in a tertiary referral cancer center, from January to September 2014, with 30 days of follow-up. A total of 43 were studied (recruited 56; excluded 13).

Main outcome measures

Determine diaphragm mobility and inspiratory muscle strength after neck dissection, using diaphragm ultrasound and by measuring maximal inspiratory pressure (MIP) and sniff nasal inspiratory pressure (SNIP).


Thirty patients underwent unilateral neck dissection, and thirteen patients underwent bilateral neck dissection. Diaphragm immobility occurred in 8.9% of diaphragms at risk. For the entire cohort, inspiratory strength decreased immediately after the dissection but returned to preoperative values after 1 month. Except for those with diaphragm immobility, diaphragm mobility remained unchanged after the dissection. One month after the dissection, the diaphragm thickness decreased, indicating diaphragm atrophy.


Immediately after a neck dissection, just a few patients showed diaphragmatic immobility, and there was a transient decrease in inspiratory strength in all individuals. Such findings can increase the risk of postoperative complications in patients with previous lung disease.


Head and neck neoplasm/surgery Neck dissection/adverse effects Respiratory Muscles Diaphragm Muscle strength 



The study was funded by FAPESP (Fundação de Amparo e Pesquisa do Estado de Sao Paulo). Grant Number: 2013/11835-6.

Compliance with ethical standards

Conflict of interest

Anne Flavia Silva Galindo Santana received a scholarship grant from “Capes” (a non-profit government agency) to participate in the study.All other authors have no conflict of interest with this manuscript.

Research involving human participants and or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Anne Flavia Silva Galindo Santana
    • 1
  • Pedro Caruso
    • 2
    • 3
  • Pauliane Vieira Santana
    • 2
    • 3
  • Gislaine Cristina Lopes Machado Porto
    • 4
  • Luiz Paulo Kowalski
    • 1
  • Jose Guilherme Vartanian
    • 1
  1. 1.Head and Neck Surgery and Otorhinolaryngology DepartmentAC Camargo Cancer CenterSão PauloBrazil
  2. 2.Intensive Care UnitAC Camargo Cancer CenterSão PauloBrazil
  3. 3.Pulmonary Division, Heart Institute (InCor)Hospital das Clínicas das Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
  4. 4.Imaging DepartmentAC Camargo Cancer CenterSão PauloBrazil

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