title: Assessment of shoulder impairment after functional neck dissection: long term results.
abstract: OBJECTIVE
  In this prospective study, we attempted to use objective techniques to measure shoulder disability and evaluate patients who underwent functional neck dissection (FND) procedure. Patients were compared on the basis of preoperative and postoperative range of motion (ROM) measurements, pain and stiffness domains. At the final visit, a Neck Dissection Impairment Index (NDII) questionnaire was applied to all patients.
  
  
  METHODS
  Twenty-five patients treated with head and neck cancer who underwent bilateral FND simultaneously with the resection of primary tumor enrolled in this study from April 2001 to July 2004. Flexion, extension, abduction, internal and external rotations of the shoulder have been measured with electronic incliometer preoperatively, and at the 1st, 3rd, 6th, and 18th months postoperatively. A questionnaire modified from neck dissection impairment index was applied to all patients to measure neck and shoulder disability at final visit. Pain and stiffness domains were also assessed preoperatively and at postoperative 18th month.
  
  
  RESULTS
  Measurements of abduction at the first and third months were found to be decreased in comparison with preoperative measurements. These differences were statistically significant (p<0.05). The pain and stiffness scores of all patients at the final visit were significantly worse than the preoperative scores (p<0.005). At the final visit NDII of patients who underwent total laryngectomy were significantly worse than of the patients who underwent partial laryngectomy and glossectomy (p=0.002 and 0.043, respectively). All these results did not correlate with age, radiation therapy (RT), operation side, T stage.
  
  
  CONCLUSIONS
  FND is oncologicaly safe procedure and gives rise to less shoulder morbidity. Although, ROM improved after 18 months from surgery, pain and stiffness were found to be worse than preoperative values. The patients with total laryngectomy had lower NDII scores regarding to other patients. Therefore, shoulder disability can be attributed not only to neck dissection but also to primary surgery.
authors.affiliation: Department of ORL, Istanbul Medical Faculty, University of Istanbul, Turkey.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Güldiken
authors.forename: K Serkan
authors.initials: KS
authors.lastname: Orhan
authors.forename: Tayfun
authors.initials: T
authors.lastname: Demirel
authors.forename: Halil Ibrahim
authors.initials: HI
authors.lastname: Ural
authors.forename: Emre A
authors.initials: EA
authors.lastname: Yücel
authors.forename: Kemal
authors.initials: K
authors.lastname: Değer
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D007822:Laryngeal Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D012720:Severity of Illness Index; D012785:Shoulder Joint / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D014062:Tongue Neoplasms / Q000601:surgery