Iatrogenic Injury to the Spinal Accessory Nerve: Late Surgery Spinal Aksesuar Sinirin ‹yatrojenik Yaralanmas›: Geç Cerrahi

The spinal accessory nerve (SAN) is responsible for the main motor innervation to the trapezius muscle. It is susceptible to iatrogenic injury as its course is superficial and close to the posterior lymph node chain and the posterior cervical triangle is covered only by skin and the investing fascia of the neck. SAN palsy may be mistaken for glenohumeral joint or muscular injury because the patient’s complaint may initially be shoulder pain. It is recommended to repair the nerve within three months after the injury for the best results, but we also obtained a good result although we operated on the patient nine months after the injury. Injury of the SAN should be considered in the differential diagnosis when there is a history of an operation in the posterior triangle of the neck. Surgical repair of the SAN results in a favorable outcome. It is possible to obtain good results even with late surgery.

[1]  Daniel H. Kim,et al.  Surgical Outcomes of 111 Spinal Accessory Nerve Injuries , 2003, Neurosurgery.

[2]  D. Willatt,et al.  Accessory nerve monitoring and stimulation during neck surgery. , 2002, The Journal of laryngology and otology.

[3]  V. Braun,et al.  Evaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma. , 2001, Journal of neurosurgery.

[4]  A. C. Kierner,et al.  Surgical anatomy of the spinal accessory nerve and the trapezius branches of the cervical plexus. , 2000, Archives of surgery.

[5]  L. Bigliani,et al.  Spinal accessory nerve injury. , 1999, Clinical orthopaedics and related research.

[6]  K. Nakamichi,et al.  Iatrogenic Injury of the Spinal Accessory Nerve. Results of Repair* , 1998, The Journal of bone and joint surgery. American volume.

[7]  E. McGillicuddy.  Nerve Injuries: Operative Results for Major Nerve Injuries, Entrapments, and Tumors. , 1997, Neurosurgery.

[8]  S. Donell,et al.  The posterior triangle and the painful shoulder: spinal accessory nerve injury. , 1996, Annals of the Royal College of Surgeons of England.

[9]  N. Barbaro,et al.  Diagnosis and treatment of iatrogenic spinal accessory nerve injury. , 1996, The American surgeon.

[10]  D. Kline,et al.  Extracranial spinal accessory nerve injury. , 1993, Neurosurgery.

[11]  G. Q. della Rovere,et al.  Innervation of the trapezius muscle: A study in patients undergoing neck dissections , 1990, Head & neck.

[12]  C. W. Kaiser,et al.  The Spinal Accessory Nerve Plexus, the Trapezius Muscle, and Shoulder Stabilization After Radical Neck Cancer Surgery , 1988, Annals of surgery.

[13]  J. Rosenørn,et al.  Microsurgical repair of iatrogenic accessory nerve lesions in the posterior triangle of the neck. , 1987, Acta chirurgica Scandinavica.

[14]  J. T. Black,et al.  Acessory nerve function after surgical procedures in the posterior triangle. , 1977, Archives of surgery.

[15]  Dunn Aw.  Trapezius paralysis after minor surgical procedures in the posterior cervical triangle. , 1974 .

[16]  A. W. Dunn.  Trapezius Paralysis After Minor Surgical Procedures in the Posterior Cervical Triangle , 1974, Southern medical journal (Birmingham, Ala. Print).

[17]  L. S. Stone,et al.  An Atlas of Anatomy , 1943, The Yale Journal of Biology and Medicine.

[18]  Klipple Feil,et al.  The shoulder , 2000 .