Consistent Level IIa Node as a Surgical Landmark for Identification of Spinal Accessory Nerve

Abstract

Introduction: Treatment of Oral Squamous Cell Carcinoma (SCC) requires a composite resection of the lesion and elective/ therapeutic neck dissection, whenever a surgical option is being considered as a form of treatment. During neck dissection, one of the critical structures to be preserved is the Spinal Accessory Nerve (SAN). In our experience of operating on N+ necks for selective neck dissections, we found the presence of a constant lymphnode at the level of hyoid bone/digastric muscle tendon lateral to the internal jugular vein (level IIa). Direct deeper dissection exactly beneath this node led to the identification of the SAN. Aim: The aim of the study was to ascertain level IIa lymph node as a landmark for identification of SAN, during neck dissection procedures. Materials and Methods: In this prospective study, 100 consecutive selective neck dissection procedures done for patients with radiological N+ necks with resectable Oral SCC were included. Results: In 96% of cases identification of SAN was done with the technique used alone. Conclusion: The purpose of this study was to establish this technique as a standard of care either alone or in adjunct with other established landmarks for identification of SAN, by trainees as has been a long established practice in our department. We even have a separate nomenclature for it, the ‘Trainee Node.

Keywords

• neck dissection
• oral scc
• shoulder syndrome