Shoulder Dysfunction after Selective Neck Dissection in Recurrent Nasopharyngeal Carcinoma

Otolaryngol Head Neck Surg. 2015 Sep;153(3):379-84. doi: 10.1177/0194599815590589. Epub 2015 Jul 2.


Objective: To investigate the incidence of occult nodal metastasis and severity of shoulder dysfunction after selective neck dissection (SND) for recurrent nasopharyngeal carcinoma (NPC) with N0 status.

Study design: Prospective, single-group, pre/post test design.

Setting: Academic medical center.

Subjects and methods: Between 1998 and 2012, 46 patients who had recurrent NPC and N0 status were recruited. They subsequently received salvage nasopharyngectomy and SND, removing ipsilateral level I to III and V lymphatics. The incidence of occult nodal metastasis was noted. All patients underwent standardized physiotherapy after surgery. Postoperative shoulder function was measured using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire.

Results: The incidence of microscopic nodal metastasis was 15.2%. For first year posttreatment, the mean DASH score was 44.2. With time, there was no improvement in shoulder function despite targeted physiotherapy (P = .09), and the second postoperative year mean DASH score was 46.3. The degree of daily activity affected was rated as moderate to very limited, and 30% of the patients had at least moderate shoulder pain at rest.

Conclusion: Shoulder dysfunction after SND for recurrent NPC is significant and persistent. Given the low incidence of microscopic nodal metastasis in such circumstances, routine SND is not recommended.

Keywords: DASH questionnaire; recurrent nasopharyngeal carcinoma; selective neck dissection; shoulder dysfunction; spinal accessory nerve.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Carcinoma
  • Disability Evaluation
  • Female
  • Hong Kong
  • Humans
  • Incidence
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Nasopharyngeal Carcinoma
  • Nasopharyngeal Neoplasms / pathology
  • Nasopharyngeal Neoplasms / surgery*
  • Neck Dissection / adverse effects*
  • Neoplasm Grading
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / surgery*
  • Pain Measurement
  • Pharyngectomy
  • Physical Therapy Modalities
  • Prospective Studies
  • Salvage Therapy
  • Shoulder / physiopathology*
  • Surgical Flaps