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American Head & Neck Society
July 21-25, 2012
Metro Toronto Convention Centre
Toronto, ON, Canada


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MORBIDITY IN SELECTIVE NECK DISSECTION A RANDOMIZED CONTROL TRIAL

Presentation: P102
Topic: Management of the Neck
Type: Poster
Date: Sunday - Tuesday, July 22 - 24, 2012
Session: Designated Poster viewing times
Authors: NEBU A GEORGE, MSDNBMRCS, PAUL SEBASTIAN, MS, BALAGOPAL P GOWRI, MSMCh
Institution(s): REGIONAL CANCER CENTRE ,TRIVANDRUM ,KERALA

Introduction: Selective neck dissection is done in stage I and II aquamous cell carcinoma of tongue as it has less morbidity compared to comprehensive neck dissection. Even selective neck dissection has its associated morbidity due to accessory nerve neuropraxia as a result of dissection around the accessory nerve to clear the Level 2B group of lymph nodes.The aim of the study was to compare the accessory nerve dysfunction in patients who undewent extended supraomohyoid neck dissection with or without level 2B dissection
Methods: 60 patients with stage I and stage II oral tongue cancers were selected, they
were randomized into two groups; Patients in the study group had removal of neck nodes from levels 1 to 4 avoiding level 2B group of neck nodes. Patients in the control group had an extended supraomohyoid neck dissection. At three weeks and at nine months postoperatively the function of the accessory nerve is evaluated clinically and by EMG.
Results: On final histopathological examination 9 patients had positive neck nodes.
5\\9 (55%) patients had metastasis in level 1B alone. 2 \\9 (22%) patients had metastasis in level 2A alone.Two patients had metastasis in multiple levels, 1B and 2 A levels in one patient and 2 A and3 levels in the other.
None of the 30 patients in the control group had level 2B positivity.
6\\30 (20%) patients in the control group and 4\\30 (13%) in the study group had accessory nerve dysfunction on first post operative EMG.
3\\30 (10%) patients of the control group had EMG changes even at 9 months; all the
patients in the study group had a normal EMG at the end of 9 months.
Conclusion:
1 In stage 1 and II oral tongue cancers level 2B nodal involvement is rare.
2 Permanent accessory nerve damage can be avoided by avoiding level 2 B dissections.

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