Abstract:
Despite recent advances using more conservative
approaches, standard classical radical neck dissection
is still one of the most frequently performed
procedures in head and neck cancer patients who have
advanced metastatic neck disease. The trapezius muscle
paralysis following division of the spinal accessory nerve
results in severe pain and cosmetic disturbance related to
malalignment of the shoulder joint. The objective of this
study is to report our results with a newly developed
orthosis to prevent and correct shoulder dysfunction
following standard radical neck dissection. Thirty-four
patients who underwent standard radical neck dissection
as a part of their surgical treatment from 1997–2002
were rehabilitated by the shoulder orthosis. Beginning
2 weeks after surgery, the patients were allowed to use
their orthosis. By using a standard questionnaire, the
pain and activity scores were recorded at the 1st, 3rd, 6th
and 12th months postoperatively. Six patients were excluded
from the study, of whom two succumbed to their
disease and four discontinued the use of the orthosis. Of
28 patients included in the study, 20 (72%) were completely
pain free within 3 months following the surgery.
Four patients (14%) noted their pain level as tolerable,
and four patients (14%) reported no considerable gain
in the pain threshold and/or physical activity levels.
Despite the fact that the active abduction range increased
only 5 to 20, the relief of pain and improved
malalignment of the scapula and consequently clavicle
and humerus led to functional gains, which increased the
patients’ endurance. At the end of the study, 23 patients
(82%) were able to return to their previous jobs or
activity levels. Current preliminary reports suggest that
this orthosis can be recommended to prevent significant
disability in patients with trapezius palsy due to ablative
cancer surgery or other reasons.
