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 preassessment • Communication errors heart of many complaints
Our Project • Rate of MMN palsy (temporary/permanent) vs. Type of ND
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
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.
Results • 75 patients • 84 neck dissections • Mean age 66. 1 (32 – 89 years) • M 4. 55: 1 F
Results • • 20 RND 20 MRND 28 SND 16 END; 16% SND; 28% • 8 patients had preoperative radiotherapy RND; 20% MRND; 20%
Results • 10/84 (11. 9%) – MMN palsy No MMN Palsy Permanent MMN Palsy Temporary MMN Palsy • 8/84 (9. 5%) – permanent • 2/84 (2. 4%) – temporary
Results • 57 neck dissections involved level I • Total palsy rate was 10/57 (18. 5%) 60 50 40 Temporary MMN palsy 30 • 14. 0% (8/57) – permanent • 3. 5% (2/57) – temporary • p-value = 0. 046 Permanent MMN palsy 20 No MMN palsy 10 0 Level II - VI
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%) 25 20 • 10% risk of a temporary MMN palsy in patients undergoing MRND 3. 6% 30 20% 10% 6. 2% Temporary MMN palsy 15 Permanent MMN palsy No MMN palsy 10 5 • Statistically insignificant 0 RND MRND SND END
Results • Parotid gland – 2 • Oral cavity – 5 • Larynx – 1 Parotid Oral cavity Larynx
Discussion • Informed consent is a vital part of preoperative assessment. • Incidence of MMN palsy post level I ND is not widely quoted. • Important patients are aware of potential morbidity and potential treatment options.
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.
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