2B or Not 2B? Shoulder Function After Level 2B Neck Dissection: A Randomized Controlled Study

Many types of head and neck cancers will have local spread to the neck. As such selective neck dissection is performed as part of the treatment. The neck is divided into various levels. Selective neck dissection targets areas that are most likely to harbor cancer cells for specific types of head and neck cancers. Level IIB has been particularly controversial in the last few years, as the rate of cancer spread to this area has been shown to be quite low (0-8%). Moreover, because the spinal accessory nerve (involved in shoulder function) runs through this area, there is theoretical risk of causing post-operative shoulder weakness. As such, the question of whether removing level IIB, knowing that there is low chance of it containing disease spread, is worth risking decreased shoulder function. Some would argue that all potential diseased sites should be removed at all costs. While other advocate that a balance between disease cure and function should be maintained. However, what needs to be determined is just what impact does dissecting IIB have on shoulder function. At our institution, the rate of poor shoulder function associated with selective neck dissection has been perceived as being quite low. This study is designed to test this observation. Hypothesis: Neck dissection including level IIb in head and neck cancer patients will not lead to worse shoulder function and quality of life than when level IIb is preserved.

Sex

All

Minimum age

18 Years

Maximum age

100 Years

Inclusion Criteria:

1. Head and neck cancer to be treated with primary surgical resection, SND and post-operative radiation therapy (RT).
2. N0 neck disease on side of the dominant hand
3. Willingness to participate in post-operative physiotherapy

Exclusion Criteria:

1. IIb positive disease found on clinical exam, CT Scan or intraoperatively (gross appearance or positive margins of frozen section of level IIa)
2. Previous neck RT
3. Previous chemotherapy
4. Invasion of spinal accessory nerve (SAN) by neck malignancy (evident on physical exam, CT scan or intraoperatively (gross appearance).
5. Previous neck dissection
6. Previous SAN injury or dysfunction
7. Preoperative signs or formal diagnosis of myopathy or neuropathy
8. Previous shoulder injury (muscular or bony)
9. Level V neck dissection
10. Recognized intraoperative sectioning of the SAN
11. Unable to provide informed consent
12. Cardiac pacemaker (contra-indication to EMG/Nerve conduction)
13. Radial forearm free flap on dominant arm

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