1 / 16

Incidence of marginal mandibular nerve palsy in neck dissection

Incidence of marginal mandibular nerve palsy in neck dissection. N Amin, H Dixon, N Gibbins , S Lew- Gor Brighton and Sussex University Hospitals United Kingdom. Marginal Mandibular Nerve. Our Project. Limited data Informed consent important part of pre-assessment

akasma
Télécharger la présentation

Incidence of marginal mandibular nerve palsy in neck dissection

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Incidence of marginal mandibular nerve palsy in neck dissection N Amin, H Dixon, N Gibbins, S Lew-Gor Brighton and Sussex University Hospitals United Kingdom

  2. Marginal Mandibular Nerve

  3. Our Project • Limited data • Informed consent important part of pre-assessment • Communication errors heart of many complaints

  4. Our Project • Rate of MMN palsy (temporary/permanent) vs. Type of ND

  5. Method • Retrospective 2 year review • 88 neck dissections (ND) reviewed • 4 excluded • 84 total • Pre- and post-operative MMN function including whether the MMN was sacrificed intra-operatively. • Time until palsy resolution • Type of neck dissection • The grade of the operating surgeon • Statistical analysis

  6. AAO-HNS classification of neck dissections • Radical neck dissection (RND)– removal of ipsilateral cervical lymph nodes in levels 1-5 as well as the sternocleidomastoid muscle (SCM), internal jugular vein (IJV) and the spinal accessory nerve (SAN). • Modified radical neck dissection (MRND)– removal of ipsilateral cervical lymph nodes in levels 1-5 with preservation of one or more of the SCM, IJV and SAN. • Selective neck dissection (SND) – there is preservation of one or more groups of lymph nodes as well as the SCM, IJV and SAN. • Extended neck dissection (END) – involves a RND with removal of another group of lymph nodes or another non-lymphatic structure.

  7. Results • 75 patients • 84 neck dissections • Mean age 66.1 (32 – 89 years) • M 4.55:1 F

  8. Results • 20 RND • 20 MRND • 28 SND • 16 END • 8 patients had pre-operative radiotherapy

  9. Results • 10/84 (11.9%) – MMN palsy • 8/84 (9.5%) – permanent • 2/84 (2.4%) – temporary

  10. Results • 57 neck dissections involved level I • Total palsy rate was 10/57 (18.5%) • 14.0% (8/57) – permanent • 3.5% (2/57) – temporary • p-value = 0.046

  11. Results • In RND there was a higher risk of a permanent MMN palsy (20%) compared to MRND (10%), SND (3.6%) or END (6.2%) • 10% risk of a temporary MMN palsy in patients undergoing MRND • Statistically insignificant 3.6% 10% 20% 6.2%

  12. Results • Parotid gland – 2 • Oral cavity – 5 • Larynx – 1

  13. Discussion • Informed consent is a vital part of pre-operative assessment. • Incidence of MMN palsy post level I ND is not widely quoted. • Important patients are aware of potential morbidity and potential treatment options.

  14. Conclusion • If level I dissection is performed, a permanent MMN palsy rate of 14% or 1 in 7 may be quoted to the patient. • Adequate resection of disease in level I and the parotid region may require sacrifice of the MMN.

  15. References • Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, et al. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg 2002;128:751-8. • Hazani R, Chowdhry S, Mowlavi A, Wilhelmi BJ. Bony anatomic landmarks to avoid injury to the marginal mandibular nerve. Aesthet Surg J. 2011 Mar;31(3):286-9. • Batra AP, Mahajan A, Gupta K. Marginal mandibular branch of the facial nerve: An anatomical study. Indian J Plast Surg. 2010 Jan;43(1):60-4. • Dingman RO, Grabb WC. Surgical anatomy of the mandibular ramus of the facial nerve based on the dissection of 100 facial halves. Plast Reconstr Surg 1962; 29:266–272 • House JW, Brackman DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985; 93:146–147  • Bron LP, O'Brien CJ. Facial nerve function after parotidectomy. Arch Otolaryngol Head Neck Surg. 1997 Oct;123(10):1091-6. • Møller MN, Sørensen CH. Risk of marginal mandibular nerve injury in neck dissection. Eur Arch Otorhinolaryngol. 2012 Feb;269(2):601-5. • Batstone MD, Scott B, Lowe D, Rogers SN. Marginal mandibular nerve injury during neck dissection and its impact on patient perception of appearance. Head Neck. 2009 May; 31(5):673-8 • Gosain AK. Surgical anatomy of the facial nerve. Clin Plast Surg. 1995 Apr;22(2):241-51. • Baker BC, Conley J. Avoiding facial nerve injuries in rhytidectomy. Anatomical variations and pitfalls. Plast Reconstr Surg 1979; 64:781–795 • Ducic Y, Young L, McIntyre J. Neck dissection: past and present. Minerva Chir. 2010 Feb;65(1):45-58. • Seddon HJ. Three types of nerve injury. Brain 1943; 66(4): 237-288 • Meier JD, Wenig BL, Manders EC, Nenonene Continuous intraoperative facial nerve monitoring in predicting postoperative injury during parotidectomy, Laryngoscope. 2006 Sep;116(9):1569-72

  16. Thank you for listening Any questions?

More Related