Accessory Nerve Injury Questions & Answers

1. Kim DH, Cho YJ, Tiel RL, et al. Surgical outcomes of 111 spinal accessory nerve injuries. Neurosurgery. 2003 Nov. 53(5):1106-12; discussion 1102-3. [QxMD MEDLINE Link].

2. Cappiello J, Piazza C, Giudice M, et al. Shoulder disability after different selective neck dissections (levels II-IV versus levels II-V): a comparative study. Laryngoscope. 2005 Feb. 115(2):259-63. [QxMD MEDLINE Link].

3. Erisen L, Basel B, Irdesel J, et al. Shoulder function after accessory nerve-sparing neck dissections. Head Neck. 2004 Nov. 26(11):967-71. [QxMD MEDLINE Link].

4. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987 Jan. 160-4. [QxMD MEDLINE Link].

5. Salerno G, Cavaliere M, Foglia A, et al. The 11th nerve syndrome in functional neck dissection. Laryngoscope. 2002 Jul. 112(7 Pt 1):1299-307. [QxMD MEDLINE Link].

6. Brown H, Burns S, Kaiser CW. The spinal accessory nerve plexus, the trapezius muscle, and shoulder stabilization after radical neck cancer surgery. Ann Surg. 1988 Nov. 208(5):654-61. [QxMD MEDLINE Link].

7. Sonne J, Lopez-Ojeda W. Neuroanatomy, Cranial Nerve. 2017 Jun. [QxMD MEDLINE Link]. [Full Text].

8. Ewing MR, Martin H. Disability following radical neck dissection; an assessment based on the postoperative evaluation of 100 patients. Cancer. 1952 Sep. 5(5):873-83. [QxMD MEDLINE Link].

9. Bodner G, Harpf C, Gardetto A, et al. Ultrasonography of the accessory nerve: normal and pathologic findings in cadavers and patients with iatrogenic accessory nerve palsy. J Ultrasound Med. 2002 Oct. 21(10):1159-63. [QxMD MEDLINE Link].

10. Tsuji T, Tanuma A, Onitsuka T, et al. Electromyographic findings after different selective neck dissections. Laryngoscope. 2007 Feb. 117(2):319-22. [QxMD MEDLINE Link].

11. Zibordi F, Baiocco F, Bascelli C, et al. Spinal accessory nerve function following neck dissection. Ann Otol Rhinol Laryngol. 1988 Jan-Feb. 97(1):83-6. [QxMD MEDLINE Link].

12. Harris HH, Dickey JR. Nerve grafting to restore function of the trapezius muscle after radical neck dissection. (A preliminary report). Ann Otol Rhinol Laryngol. 1965 Sep. 74(3):880-6. [QxMD MEDLINE Link].

13. Guo CB, Zhang Y, Zou LD, et al. Reconstruction of accessory nerve defects with sternocleidomastoid muscle-great auricular nerve flap. Br J Plast Surg. 2005 Mar. 58(2):233-8. [QxMD MEDLINE Link].

14. Chandawarkar RY, Cervino AL, Pennington GA. Management of iatrogenic injury to the spinal accessory nerve. Plast Reconstr Surg. 2003 Feb. 111(2):611-7; discussion 618-9. [QxMD MEDLINE Link].

15. Leipzig B, Suen JY, English JL, et al. Functional evaluation of the spinal accessory nerve after neck dissection. Am J Surg. 1983 Oct. 146(4):526-30. [QxMD MEDLINE Link].

16. Prim MP, De Diego JI, Verdaguer JM, et al. Neurological complications following functional neck dissection. Eur Arch Otorhinolaryngol. 2006 May. 263(5):473-6. [QxMD MEDLINE Link].

17. Popovski V, Benedetti A, Popovic-Monevska D, Grcev A, Stamatoski A, Zhivadinovik J. Spinal accessory nerve preservation in modified neck dissections: surgical and functional outcomes. Acta Otorhinolaryngol Ital. 2017 Oct. 37 (5):368-74. [QxMD MEDLINE Link]. [Full Text].

18. Keles Z, Zinnuroglu M, Beyazova M. Impairment of upper trapezius branch of the spinal accessory nerve during bypass grafting: a stretch injury?. Muscle Nerve. 2010 Jan. 41(1):144-7. [QxMD MEDLINE Link].

19. Millett PJ, Romero A, Braun S. Spinal accessory nerve injury after rhytidectomy (face lift): a case report. J Shoulder Elbow Surg. 2009 Sep-Oct. 18(5):e15-7. [QxMD MEDLINE Link].

20. Bodack MP, Tunkel RS, Marini SG, et al. Spinal accessory nerve palsy as a cause of pain after whiplash injury: case report. J Pain Symptom Manage. 1998 May. 15(5):321-8. [QxMD MEDLINE Link].

21. Khalid S, Zaheer S, Khalid M, et al. Collet-Sicard syndrome secondary to a large glomus jugulotympanicum. Ann Saudi Med. 2013 Jul-Aug. 33(4):407-10. [QxMD MEDLINE Link].

22. Jo YR, Chung CW, Lee JS, et al. Vernet syndrome by varicella-zoster virus. Ann Rehabil Med. 2013 Jun. 37(3):449-52. [QxMD MEDLINE Link]. [Full Text].

23. Kassem MW, Iwanaga J, Loukas M, et al. Accessory neuropathy after sternotomy: clinico-anatomical correlation supporting an inflammatory cause. Clin Anat. 2017 Nov 28. [QxMD MEDLINE Link].

24. Ozdemir O, Kurne A, Temucin C, et al. Spontaneous unilateral accessory nerve palsy: a case report and review of the literature. Clin Rheumatol. 2007 Sep. 26(9):1581-3. [QxMD MEDLINE Link].

25. Kierner AC, Burian M, Bentzien S, et al. Intraoperative electromyography for identification of the trapezius muscle innervation: clinical proof of a new anatomical concept. Laryngoscope. 2002 Oct. 112(10):1853-6. [QxMD MEDLINE Link].

26. Macaluso S, Ross DC, Doherty TJ, Doherty CD, Miller TA. Spinal accessory nerve injury: a potentially missed cause of a painful, droopy shoulder. J Back Musculoskelet Rehabil. 2016 Nov 21. 29 (4):899-904. [QxMD MEDLINE Link].

27. Nahum AM, Mullally W, Marmor L. A syndrome resulting from radical neck dissection. Arch Otolaryngol. 1961 Oct. 74:424-8. [QxMD MEDLINE Link].

28. Piazza C, Cappiello J, Nicolai P. Sternoclavicular joint hypertrophy after neck dissection and upper trapezius myocutaneous flap transposition. Otolaryngol Head Neck Surg. 2002 Feb. 126(2):193-4. [QxMD MEDLINE Link].

29. Shiozaki K, Abe S, Agematsu H, et al. Anatomical study of accessory nerve innervation relating to functional neck dissection. J Oral Maxillofac Surg. 2007 Jan. 65(1):22-9. [QxMD MEDLINE Link].

30. Overland J, Hodge JC, Breik O, Krishnan S. Surgical anatomy of the spinal accessory nerve: review of the literature and case report of a rare anatomical variant. J Laryngol Otol. 2016 Oct. 130 (10):969-72. [QxMD MEDLINE Link].

31. Lanisnik B. Different branching patterns of the spinal accessory nerve: impact on neck dissection technique and postoperative shoulder function. Curr Opin Otolaryngol Head Neck Surg. 2017 Apr. 25 (2):113-8. [QxMD MEDLINE Link].

32. Tubbs RS, Stetler W, Louis RG Jr, Gupta AA, Loukas M, Kelly DR, et al. Surgical challenges associated with the morphology of the spinal accessory nerve in the posterior cervical triangle: functional or structural?. J Neurosurg Spine. 2010 Jan. 12(1):22-4. [QxMD MEDLINE Link].

33. Hone SW, Ridha H, Rowley H, et al. Surgical landmarks of the spinal accessory nerve in modified radical neck dissection. Clin Otolaryngol Allied Sci. 2001 Feb. 26(1):16-8. [QxMD MEDLINE Link].

34. Gardiner KJ, Irvine BW, Murray A. Anomalous relationship of the spinal accessory nerve to the internal jugular vein. Clin Anat. 2002 Jan. 15(1):62-3. [QxMD MEDLINE Link].

35. Gray HR, Warwick PL, Williams. Gray's anatomy. 36th ed. Philadelphia Edingurgh; New York Churchill Livingstone: Saunders; xvii 1578; 1980.

36. Chepeha DB, Taylor RJ, Chepeha JC, et al. Functional assessment using Constant's Shoulder Scale after modified radical and selective neck dissection. Head Neck. 2002 May. 24(5):432-6. [QxMD MEDLINE Link].

37. Salgarelli AC, Landini B, Bellini P, Multinu A, Consolo U, Collini M. A simple method of identifying the spinal accessory nerve in modified radical neck dissection: anatomic study and clinical implications for resident training. Oral Maxillofac Surg. 2009 Jun. 13(2):69-72. [QxMD MEDLINE Link].

38. DeLisa, JA. Rehabilitation medicine: principles and practice. 1993. 2nd ed. Philadelphia: 1238: Lippincott. xxiii;

39. Powell GM, Baffour FI, Baillargeon AM, Spinner RJ, Glazebrook KN. Preoperative ultrasound accurately characterizes surgically confirmed extracranial spinal accessory nerve injuries. Skeletal Radiol. 2021 Oct 22. [QxMD MEDLINE Link].

40. Kim KH, Shin S, Kim DH. Optimal Trapezius Electrophysiological Recording Site. PM R. 2019 Nov 1. [QxMD MEDLINE Link].

41. Witt RL, Rejto L. Spinal accessory nerve monitoring in selective and modified neck dissection. Laryngoscope. 2007 May. 117(5):776-80. [QxMD MEDLINE Link].

42. Rogers SN, Scott B, Lowe D. An evaluation of the shoulder domain of the University of Washington quality of life scale. Br J Oral Maxillofac Surg. 2007 Jan. 45(1):5-10. [QxMD MEDLINE Link].

43. Teboul F, Bizot P, Kakkar R, et al. Surgical management of trapezius palsy. J Bone Joint Surg Am. 2004 Sep. 86-A(9):1884-90. [QxMD MEDLINE Link].

44. Gordon SL, Graham WP 3rd, Black JT, et al. Acessory nerve function after surgical procedures in the posterior triangle. Arch Surg. 1977 Mar. 112(3):264-8. [QxMD MEDLINE Link].

45. Kizilay A, Kalcioglu MT, Saydam L, et al. A new shoulder orthosis for paralysis of the trapezius muscle after radical neck dissection: a preliminary report. Eur Arch Otorhinolaryngol. 2006 May. 263(5):477-80. [QxMD MEDLINE Link].

46. Akgun K, Aktas I, Uluc K. Conservative treatment for late-diagnosed spinal accessory nerve injury. Am J Phys Med Rehabil. 2008 Dec. 87(12):1015-21. [QxMD MEDLINE Link].

47. McGarvey AC, Hoffman GR, Osmotherly PG, et al. Maximizing shoulder function after accessory nerve injury and neck dissection surgery: A multicenter randomized controlled trial. Head Neck. 2014 Jul 11. [QxMD MEDLINE Link].

48. Osgaard O, Eskesen V, Rosenørn J. Microsurgical repair of iatrogenic accessory nerve lesions in the posterior triangle of the neck. Acta Chir Scand. 1987 Mar. 153(3):171-3. [QxMD MEDLINE Link].

49. Weisberger EC, Kincaid J, Riteris J. Cable grafting of the spinal accessory nerve after radical neck dissection. Arch Otolaryngol Head Neck Surg. 1998 Apr. 124(4):377-80. [QxMD MEDLINE Link].

50. Maldonado AA, Spinner RJ. Lateral pectoral nerve transfer for spinal accessory nerve injury. J Neurosurg Spine. 2017 Jan. 26 (1):112-5. [QxMD MEDLINE Link].

51. Dvali L, Mackinnon S. Nerve repair, grafting, and nerve transfers. Clin Plast Surg. 2003 Apr. 30(2):203-21. [QxMD MEDLINE Link].

52. Millesi H, Meissl G, Berger A. The interfascicular nerve-grafting of the median and ulnar nerves. J Bone Joint Surg Am. 1972 Jun. 54(4):727-50. [QxMD MEDLINE Link].

53. Maki Y, Firrell JC, Breidenbach WC. Blood flow in mobilized nerves: results in a rabbit sciatic nerve model. Plast Reconstr Surg. 1997 Sep. 100(3):627-33; discussion 634-5. [QxMD MEDLINE Link].

54. Ducic I, Maloney CT Jr, Dellon AL. Reconstruction of the spinal accessory nerve with autograft or neurotube? Two case reports. J Reconstr Microsurg. 2005 Jan. 21(1):29-33; discussion 34. [QxMD MEDLINE Link].

55. den Dunnen WF, van der Lei B, Schakenraad JM, et al. Poly(DL-lactide-epsilon-caprolactone) nerve guides perform better than autologous nerve grafts. Microsurgery. 1996. 17(7):348-57. [QxMD MEDLINE Link].

56. Meek MF, Den Dunnen WF, Schakenraad JM, et al. Long-term evaluation of functional nerve recovery after reconstruction with a thin-walled biodegradable poly (DL-lactide-epsilon-caprolactone) nerve guide, using walking track analysis and electrostimulation tests. Microsurgery. 1999. 19(5):247-53. [QxMD MEDLINE Link].

57. Lange M. [Treatment of paralysis of the trapezius.]. Langenbecks Arch Klin Chir Ver Dtsch Z Chir. 1951 Nov 17. 270:437-9. [QxMD MEDLINE Link].

58. Mayer JA, Hruby LA, Salminger S, Bodner G, Aszmann OC. Reconstruction of the spinal accessory nerve with selective fascicular nerve transfer of the upper trunk. J Neurosurg Spine. 2019 Apr 5. 1-6. [QxMD MEDLINE Link].

59. Donner TR, Kline DG. Extracranial spinal accessory nerve injury. Neurosurgery. 1993 Jun. 32(6):907-10; discussion 911. [QxMD MEDLINE Link].

60. Kraus DH, Rosenberg DB, Davidson BJ, et al. Supraspinal accessory lymph node metastases in supraomohyoid neck dissection. Am J Surg. 1996 Dec. 172(6):646-9. [QxMD MEDLINE Link].

61. Permanyer-Miralda G, Soler-Soler J, Casan-Cava JM, Tornos-Mas MP. Medium term fate of dura mater valvular bioprostheses. Eur Heart J. 1980 Jun. 1 (3):195-9. [QxMD MEDLINE Link].

62. Eickmeyer SM, Walczak CK, Myers KB, et al. Quality of life, shoulder range of motion, and spinal accessory nerve status in 5-year survivors of head and neck cancer. PM R. 2014 Dec. 6(12):1073-80. [QxMD MEDLINE Link]. [Full Text].

63. Park SH, Esquenazi Y, Kline DG, Kim DH. Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures. J Neurosurg Spine. 2015 Oct. 23 (4):518-25. [QxMD MEDLINE Link].

64. Goransson H, Leppanen OV, Vastamaki M. Patient outcome after surgical management of the spinal accessory nerve injury: A long-term follow-up study. SAGE Open Med. 2016. 4:2050312116645731. [QxMD MEDLINE Link]. [Full Text].

65. Lanisnik B, Zitnik L, Levart P, Zargi M, Rodi Z. The impact on post-operative shoulder function of intraoperative nerve monitoring of cranial nerve XI during modified radical neck dissection. Eur Arch Otorhinolaryngol. 2016 Dec. 273 (12):4445-51. [QxMD MEDLINE Link].

66. Birinci Y, Genc A, Ecevit MC, et al. Spinal Accessory Nerve Monitoring and Clinical Outcome Results of Nerve-Sparing Neck Dissections. Otolaryngol Head Neck Surg. 2014 Aug. 151 (2):253-9. [QxMD MEDLINE Link].

67. McGarvey AC, Hoffman GR, Osmotherly PG, Chiarelli PE. Intra-operative monitoring of the spinal accessory nerve: a systematic review. J Laryngol Otol. 2014 Sep. 128 (9):746-51. [QxMD MEDLINE Link].

68. Barber B, Seikaly H, Ming Chan K, et al. Intraoperative Brief Electrical Stimulation of the Spinal Accessory Nerve (BEST SPIN) for prevention of shoulder dysfunction after oncologic neck dissection: a double-blinded, randomized controlled trial. J Otolaryngol Head Neck Surg. 2018 Jan 23. 47 (1):7. [QxMD MEDLINE Link]. [Full Text].

Rohan R Walvekar, MD Clinical Professor, Mervin L Trail Endowed Chair in Head and Neck Oncology, Director, Salivary Endoscopy Service, Co-Director, ENT Service, Department of Otolaryngology-Head and Neck Surgery, University Medical Center, Louisiana State University Health Sciences Center

Rohan R Walvekar, MD is a member of the following medical societies: American Head and Neck Society, Association of Otolaryngologists of India

Disclosure: Received royalty from Hood Laboratories for consulting; Received consulting fee from Cook Industries for consulting; Received consulting fee from Medtronic Xomed for consulting.

Neelam P Phalke, MD Resident Physician, Department of Otolaryngology-Head Neck Surgery, Louisiana State University Health Sciences Center

Neelam P Phalke, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ted L Tewfik, MD Professor of Otolaryngology-Head and Neck Surgery, Professor of Pediatric Surgery, McGill University Faculty of Medicine; Senior Staff, Montreal Children's Hospital, Montreal General Hospital, and Royal Victoria Hospital

Ted L Tewfik, MD is a member of the following medical societies: American Society of Pediatric Otolaryngology, Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Jaime R Garza, MD, DDS, FACS Consulting Staff, Private Practice

Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, Texas Society of Plastic Surgeons

Disclosure: Received none from Allergan for speaking and teaching; Received none from LifeCell for consulting; Received grant/research funds from GID, Inc. for other.

Kristin B Gendron, MD Consulting Staff, Midwest ENT Specialists

Kristin B Gendron, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Ryan J Li, MD Resident Physician, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital and Health System

Ryan J Li, MD is a member of the following medical societies: Alpha Omega Alpha, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Duncan Hanby, MD Resident Physician, Department of Otolaryngology and Head and Neck Surgery, Louisiana State University School of Medicine

Duncan Hanby, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Medical Association

Disclosure: Nothing to disclose.

The author would like to thank Dr. A.K. D’Cruz, MS, DNB, Professor and Chairman, Head/Neck Surgery, Tata Memorial Hospital, Mumbai, India, for Image 7, and Dr. Umamaheshwar Duvvuri, MD, PhD, Fellow, Head/Neck Surgery, MD Anderson Cancer Center, Houston, Texas, for Image 8.

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