Comparison of spinal accessory dysfunction following neck dissection with harmonic scalpel and electrocautery – A randomized study

• Technique of neck dissection (Harmonic VS electro cautery) has significant impact on shoulder dysfunction in postoperative period.
• Shoulder function (Shoulder pain and shoulder function) was same in both the groups at 1 week, 1 month.
• At 3 months and 6 months shoulder function (shoulder pain and shoulder movement) was found to be better in harmonic scalpel group.
• Better recovery of shoulder functions are seen with harmonic scalpel group as compared to electrocautery group.
• Electrocautery causes more thermal dissipation as compared to harmonic scalpel due to which recovery after damage to spinal accessory nerve is delayed in electrocautery group.

IntroductionHarmonic scalpel is being increasingly used in neck dissection as alternative to conventional electro-cautery for achieving haemostasis. Use of harmonic scalpel has been shown to significantly reduce intra operative blood loss and intra operative time in neck dissection. But how safe is it with regards to nerve injury (spinal accessory nerve and other nerves) during neck dissection. We intended to study the spinal accessory nerve injury during neck dissection by both harmonic scalpel and electro cautery technique and compared postoperative recovery of shoulder function after neck dissection.Methods40 patients undergoing selective neck dissection for primary oral malignancy were enrolled in this study. The Harmonic scalpel (HS) group consisted of 20 patients, and the electo cautery technique (ET) group had 20 patients. The following variables were examined: shoulder pain by visual analog scoring and shoulder function by means of degree of abduction and graded was grade I-0–90°; grade II-90–135°; grade III-135–180°. They assessment was done at the time of discharge, 1 month and 3 month and six month after surgery.ResultsThough shoulder pain was almost similar at 1st week and 1 month, however at 2nd and 6th month shoulder pain was found to be significantly lesser in harmonic scalpel group as compared to electro cautery. At 1 week more no of patients had restricted shoulder mobility in HS as compared to EC group. But at 6 months the shoulder function was found to be significantly better in HS group as compared to EC group (p value < 0.05).ConclusionSpinal accessory nerve function recovery after selective neck dissection is better in HS group as compared to the electro cautery group.