Complaints of neuropathic pain, noxious cervical plexus neuropathy and neck tightness are reported by patients who undergo neck dissection: an institutional study and narrative review.

There exists a subgroup of patients who undergo neck dissection (ND) who postoperatively complain of either neuropathic pain, dysaesthesia and/or discomfort that is located within the dermatomal distribution of the cervical plexus. The purpose of our study was to determine the prevalence, characteristic, and demographics of these symptoms in our patient cohort. We undertook a retrospective randomised observational cohort study of 105 patients who had undergone ND. The primary predictor variable was the undertaking of a ND. The secondary outcome variable was the complaint of either neuropathic pain or a noxious neuropathy, at a minimum of twelve months after surgery. A recognised symptom questionnaire and a visual analogue score was employed for the purpose of the study. A descriptive and statistical analysis was applied to the assembled data. Twenty patients (19%) complained of either spontaneous (n=9) or evoked (n=11) neuropathic pain that occurred within the surgical site. In addition, 71 patients (68%) described an altered sensation in the dermatomal distribution of the great auricular or tranverse cervical nerves while 70 patients (67%) described the feeling of 'neck tightness'. There were no characteristics of the study cohort that underpinned these results. Neuropathic pain can occur following ND. This can cause distress to a small but defined group of patients. Despite its importance, we found a paucity of studies in the literature that have investigated neuropathic pain following ND. We believe this condition requires more research attention and clinical awareness.

Intra-operative monitoring of the spinal accessory nerve: a systematic review.

OBJECTIVE: To investigate evidence that intra-operative nerve monitoring of the spinal accessory nerve affects the prevalence of post-operative shoulder morbidity and predicts functional outcome. METHODS: A search of the Medline, Scopus and Cochrane databases from 1995 to October 2012 was undertaken, using the search terms 'monitoring, intra-operative' and 'accessory nerve'. Articles were included if they pertained to intra-operative accessory nerve monitoring undertaken during neck dissection surgery and included a functional shoulder outcome measure. Further relevant articles were obtained by screening the reference lists of retrieved articles. RESULTS: Only three articles met the inclusion criteria of the review. Two of these included studies suggesting that intra-operative nerve monitoring shows greater specificity than sensitivity in predicting post-operative shoulder dysfunction. Only one study, with a small sample size, assessed intra-operative nerve monitoring in neck dissection patients. CONCLUSION: It is unclear whether intra-operative nerve monitoring is a useful tool for reducing the prevalence of accessory nerve injury and predicting post-operative functional shoulder outcome in patients undergoing neck dissection. Larger, randomised studies are required to determine whether such monitoring is a valuable surgical adjunct.

Lymphoedema following treatment for head and neck cancer: impact on patients, and beliefs of health professionals.

Cervicofacial lymphoedema is a recognised side-effect that may result following treatment for head and neck cancer. This study aimed to investigate the perspectives of affected patients and the beliefs that treating health professionals hold about head and neck lymphoedema. Ten patients with head and neck lymphoedema and 10 health professionals experienced in the treatment of head and neck cancer patients agreed to participate in semi-structured face to face interviews. Interviews were recorded, audio files were transcribed and coded and then analysed for themes. Themes of experiences of patients with head and neck lymphoedema and the beliefs of health professionals largely overlapped. Given its visible deformity, the main effect of lymphoedema in head and neck cancer patients was on appearance. In some cases this lead to negative psychosocial sequelae such as reduced self-esteem, and poor socialisation. Clinicians need to be aware of those patients more likely to experience lymphoedema following treatment for head and neck cancer, and how they are affected. Understanding how patients with facial lymphoedema are affected psychologically and physically, and the importance of prompt referral for lymphoedema treatment, might ultimately improve outcomes and ensure optimal management.