Advertisement

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

Abstract

Background

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

Objective

Evaluate diaphragm mobility and inspiratory strength after neck dissection.

Methods

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).

Results

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.

Conclusions

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.

Keywords

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

Notes

Acknowledgements

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.

References

  1. 1.
    Ferlito A, Robbins KT, Shah JP, Medina JE, Silver CE, Al-Tamimi S et al (2011) Proposal for a rational classification of neck dissections. Head Neck 33:445–450PubMedGoogle Scholar
  2. 2.
    Vartanian JG, Pontes E, Agra IM, Campos OD, Goncalves-Filho J, Carvalho AL et al. (2003) Distribution of metastatic lymph nodes in oropharyngeal carcinoma and its implications for the elective treatment of the neck. Arch Otolaryngol Head Neck Surg 129:729–732CrossRefPubMedGoogle Scholar
  3. 3.
    Laghi F, Tobin MJ (2003) Disorders of the respiratory muscles. Am J Respir Crit Care Med 168:10–48CrossRefPubMedGoogle Scholar
  4. 4.
    McCool FD, Tzelepis GE (2012) Dysfunction of the diaphragm. N Engl J Med 366:932–942CrossRefPubMedGoogle Scholar
  5. 5.
    Rochester DF, Farkas GA (1995) Performance of respiratory muscles in situ. In: Roussos C (ed) The thorax: applied physiology. Marcel Dekker, New York. 1127–1159Google Scholar
  6. 6.
    Siafakas NM, Mitrouska I, Bouros D, Georgopoulos D (1999) Surgery and the respiratory muscles. Thorax 54:458–465CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bergman NA, Tien YK (1983) Contribution of the closure of pulmonary units to impaired oxygenation during anesthesia. Anesthesiology 59:395–401CrossRefPubMedGoogle Scholar
  8. 8.
    Shander A, Fleisher LA, Barie PS, Bigatello LM, Sladen RN, Watson CB (2011) Clinical and economic burden of postoperative pulmonary complications: patient safety summit on definition, risk-reducing interventions, and preventive strategies. Crit Care Med 39:2163–2172CrossRefPubMedGoogle Scholar
  9. 9.
    de Jong AA, Manni JJ (1991) Phrenic nerve paralysis following neck dissection. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino. Laryngol Soc 248:132–134Google Scholar
  10. 10.
    Moorthy SS, Gibbs PS, Losasso AM, Lingeman RE (1983) Transient paralysis of the diaphragm following radical neck surgery. Laryngoscope 93:642–644CrossRefPubMedGoogle Scholar
  11. 11.
    Yaddanapudi S, Shah SC (1996) Bilateral phrenic nerve injury after neck dissection: an uncommon cause of respiratory failure. J Laryngol Otol 110:281–283PubMedGoogle Scholar
  12. 12.
    Gottesman E, McCool FD (1997) Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med 155:1570–1574CrossRefPubMedGoogle Scholar
  13. 13.
    Boon AJ, Harper CJ, Ghahfarokhi LS, Strommen JA, Watson JC, Sorenson EJ (2013) Two-dimensional ultrasound imaging of the diaphragm: quantitative values in normal subjects. Muscle Nerve 47:884–889CrossRefPubMedGoogle Scholar
  14. 14.
    Testa A, Soldati G, Giannuzzi R, Berardi S, Portale G, Gentiloni Silveri N (2011) Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects. Ultrasound Med Biol 37:44–52CrossRefPubMedGoogle Scholar
  15. 15.
    Piccirillo JF, Feinstein AR (1996) Clinical symptoms and comorbidity: significance for the prognostic classification of cancer. Cancer 77:834–842CrossRefPubMedGoogle Scholar
  16. 16.
    Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET et al. (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655CrossRefPubMedGoogle Scholar
  17. 17.
    American Thoracic Society/European Respiratory S. (2002) ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med 166:518–624CrossRefGoogle Scholar
  18. 18.
    Steier J, Kaul S, Seymour J, Jolley C, Rafferty G, Man W et al (2007) The value of multiple tests of respiratory muscle strength. Thorax 62:975–80CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Boussuges A, Gole Y, Blanc P (2009) Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 135:391–400CrossRefPubMedGoogle Scholar
  20. 20.
    Cohn D, Benditt JO, Eveloff S, McCool FD (1997) Diaphragm thickening during inspiration. J Appl Physiol 83:291–296CrossRefPubMedGoogle Scholar
  21. 21.
    Ueki J, De Bruin PF, Pride NB (1995) In vivo assessment of diaphragm contraction by ultrasound in normal subjects. Thorax 50:1157–1161CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Lerolle N, Guerot E, Dimassi S, Zegdi R, Faisy C, Fagon JY et al (2009) Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery. Chest 135:401–407CrossRefPubMedGoogle Scholar
  23. 23.
    Kim SH, Na S, Choi JS, Na SH, Shin S, Koh SO (2010) An evaluation of diaphragmatic movement by M-mode sonography as a predictor of pulmonary dysfunction after upper abdominal surgery. Anesthesia Analgesia 110:1349–1354CrossRefPubMedGoogle Scholar
  24. 24.
    Matamis D, Soilemezi E, Tsagourias M, Akoumianaki E, Dimassi S, Boroli F et al (2013) Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive Care Med 39:801–10CrossRefPubMedGoogle Scholar
  25. 25.
    Iverson LI, Mittal A, Dugan DJ, Samson PC (1976) Injuries to the phrenic nerve resulting in diaphragmatic paralysis with special reference to stretch trauma. Am J Surg 132:263–269CrossRefPubMedGoogle Scholar
  26. 26.
    Rosett RL (1987) An unusual cause of postoperative respiratory failure. Anesthesiology 66:695–697CrossRefPubMedGoogle Scholar
  27. 27.
    Goligher EC, Laghi F, Detsky ME, Farias P, Murray A, Brace D et al (2015) Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity. Intensive Care Med 41:734CrossRefPubMedGoogle Scholar
  28. 28.
    Baldwin CE, Paratz JD, Bersten AD (2011) Diaphragm and peripheral muscle thickness on ultrasound: intra-rater reliability and variability of a methodology using non-standard recumbent positions. Respirology 16:1136–1143CrossRefPubMedGoogle Scholar
  29. 29.
    Sarwal A, Parry SM, Berry MJ, Hsu FC, Lewis MT, Justus NW et al. (2015) Interobserver reliability of quantitative muscle sonographic analysis in the critically ill population. J Ultrasound Med Off J Am Instit Ultrasound In Med 34:1191–200Google Scholar
  30. 30.
    Nava S, Ambrosino N, Crotti P, Fracchia C, Rampulla C (1993) Recruitment of some respiratory muscles during three maximal inspiratory manoeuvres. Thorax 48:702–707CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Verin E, Delafosse C, Straus C, Morelot-Panzini C, Avdeev S, Derenne JP et al (2001) Effects of muscle group recruitment on sniff transdiaphragmatic pressure and its components. Eur J Appl Physiol 85:593–598CrossRefPubMedGoogle Scholar
  32. 32.
    Vassilakopoulos T, Mastora Z, Katsaounou P, Doukas G, Klimopoulos S, Roussos C et al (2000) Contribution of pain to inspiratory muscle dysfunction after upper abdominal surgery: a randomized controlled trial. American J Respir Crit Care Med 161:1372–1375CrossRefGoogle Scholar
  33. 33.
    Goligher EC, Fan E, Herridge MS, Murray A, Vorona S, Brace D et al (2015) Evolution of diaphragm thickness during mechanical ventilation: impact of inspiratory effort. Am J Respir Crit Care Med 192(9):1080–1088CrossRefPubMedGoogle Scholar
  34. 34.
    Evans WJ (2010) Skeletal muscle loss: cachexia, sarcopenia, and inactivity. Am J Clin Nutr 91:1123S–1127SCrossRefPubMedGoogle Scholar
  35. 35.
    Laroche CM, Carroll N, Moxham J, Green M (1988) Clinical significance of severe isolated diaphragm weakness. Am Rev Respir Dis 138:862–866CrossRefPubMedGoogle Scholar
  36. 36.
    Teitelbaum J, Borel CO, Magder S, Traystman RJ, Hussain SN (1993) Effect of selective diaphragmatic paralysis on the inspiratory motor drive. J Appl Physiol 74:2261–2268CrossRefPubMedGoogle Scholar

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

Personalised recommendations