Friday, February 8, 2013

Radical Neck Dissection

In August last year my 23 y.o. son had what was described to us as a radical neck dissection. He had melanoma in the lymph nodes on the right side of his neck. They removed 80+ lymph nodes. He did not require radium or chemo. I have 2 questions, on reading your description I don't believe they removed the spinal accessory nerve, internal jugular or the muscle you mentioned, so not sure if it was a complete RND. First question is he has noticed that around his neck and shoulder area where he is still quite numb he does not sweat....is this common? Second question is he has just begun physio because he has limited use of his shoulder....cannot lift his arm very high and the physio has said that a muscle has been moved and is now pulling his shoulder blade in the wrong direction...is this correctable?

JOHN SAUNDERS JR, MD replies...
A neck dissection the removes or injuries (it may lose its function even when it is preserved) the spinal accessory nerve results in weakness of the trapezius muscle and the sternocleidomastoid muscle. Of these two, the trapezius is more important. Without this muscle one cannot raise his arm about 90 degrees when extended laterally. It also causes winging of the scapula. When this is a permanent condition of the muscle, physical therapy to strengthen the other surrounding muscles can be helpful. Surgical procedures to help this condition are less effective. They include a procedure that "fixes" the scapula to some of the ribs so that it is rigidly held inward to facilitate the raising of the arm above the shoulder. This is a rarely performed procedure and would be done by an orthopedic surgeon.

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