An unusual case of a radical neck dissection without the development of a shoulder syndrome

Iatrogenic damage to the spinal accessory nerve is very common during surgical procedures in the neck region, especially during oncological surgery. An injury to this nerve can cause different deficiencies, from a poorly definable painful symptomatology of the shoulder to a motor deficit of the shoulder girdle due to a denervation of the trapezius muscle, a condition known as Shoulder Syndrome (SS). In literature it is reported that the presence of an accessory innervation of the trapezius muscle rising from the cervical plexus (C2–C4) can contribute to, and in some cases replace, the innervation of the trapezius muscle by the accessory nerve. In this study we show a case of a patient, who had undergone a radical neck dissection, who did not report a functional deficit of the shoulder, strengthening the hypothesis of a replacement innervation starting from the cervical plexus (C2–C4). It is therefore important to preserve this innervation during surgical procedures involving the neck due to the positive impact it would have on the patient's Quality of Life (QOL).