INFLUENCE OF NECK DISSECTION ON THE CORRESPONDING MOTOR AND SENSORY NERVES
Autori:
Aleksandar Milenović, Predrag Knežević, Vanja Vučićević Boras, Dragana Gabrić, Ana Andabak Rogulj, Mišo Virag
Sažetak
Uvod: Radikalna disekcija vrata rabi se u svrhu liječenja metastaza u limfnim čvorovima bolesnika s karcinomom glave i vrata i može dovesti do znatnoga funkcionalnog poremećaja koji nastaje kao posljedica oštećenja živaca. U literaturi postoje oskudni podatci o poslijeoperativnim analizama utjecaja radikalne disekcije vrata na kranijalne i cervikalne živce s obzirom na disekciju vrata koja se radi elektronožem ili skalpelom.Materijal i metode: U istraživanje je bilo uključeno 48-ero bolesnika (42 muškarca i 6 žena) s dijagnozom intraoralnog karcinoma. Provedeno je ukupno 55 disekcija, uključujući i 7 bolesnika kod kojih je učinjena bilateralna disekcija. Analiza oštećenja motoričkih i osjetnih živaca provedena je tri mjeseca nakon što su bolesnici bili podvrgnuti disekciji vrata elektronožem ili skalpelom. Rezultati: Najčešći postoperativni motorički gubitak funkcije ustanovljen je u akcesornom i hipoglosalnom živcu, dok je osjetni gubitak funkcije najčešće ustanovljen u jezičnom živcu. Trajna disfunkcija dijafragme zabilježena je u 15% ispitanih pacijenata. Zaključak:Potrebna je rutinska evaluacija senzoneuralne i motoričke funkcije svih potencijalno ugroženih živaca nakon radikalne disekcije vrata, a posebno funkcije dijafragme. Nije bilo razlika u poslijeoperativnom nalazu ispitivanih živaca s obzirom na uporabu elektronoža ili skalpela.
Summary
Objective: Radical neck dissection (RND), utilized for treatment of lymph node metastases in patients with head and neck cancers, can result in clinically significant functional disturbance secondary to the corresponding nerve damage. However, there is only limited data relative to post-operative analysis of impact of RND on the cranial and cervical nerves after neck dissection especially regarding the technique used such as electroknife or scalpel. Study design: 48 patients (42 men and 6 women) with intraoral cancer were enrolled. A total of 55 dissections were performed, including 7 patients who received bilateral dissections. Analysis of motor and sensory nerves was conducted seven days and three months later with regard whether electroknife or scalpel was used. Results: The most frequent post-operative loss of motor function was seen in accessory and hypoglossal nerves; within sensory nerves the lingual nerve was most frequently dysfunctional. Permanent diaphragm dysfunction was seen in 15% of investigated patients. Conclusion: We might conclude that routine evaluation of sensoneural and motor nerve function of all potentially damaged nerves should be performed after RND, especially regarding diaphragm paralysis. There were no differences in postoperative nerve function of the examined nerves with regard to the technique used (electroknife/scalpel).
