[Surgical anatomy and preservation of the accessory nerve in radical functional neck dissection].

OBJECTIVE: The surgical anatomy and preservation of the accessory nerve in radical functional neck dissection were studied. METHODS: Thirty-three cN(0) patients with oral cancers were entered into the study. Radical functional neck dissection were performed and the relations between the accessory nerve and its surrounding structures were recorded. RESULTS: The accessory nerve going through or beneath the sternocleidomastoid muscle occurred in 82% (27/33) and 18% (6/33) of the patients respectively. Communicating branches between the accessory and the cervical nerves were found in 85% (28/33). There was 2 to 3 cm of the accessory nerve paralleled to the anterior border of the trapezius muscle before it entered the muscle in 70% (23/33). The dissection of the nerve needed 20 to 30 minutes. Twenty-seven percent of the patients had pathologically proved lymph node metastases. CONCLUSIONS: Looking for accessory nerve under the upper portion of the sternocleidomastoid muscle and above the middle point of the muscle posterior border is simple and safe. The point of the great auricular nerve going out the muscle is an important indicator for finding the accessory nerve.