Objectives: The purpose of this presentation is to provide a way to manage this complication, define a clinical 'danger zone', and increase awareness of the course of the nerve and minimise the risk of injury. In addition, this presentation will discuss rescue procedures.
Introduction: Cervicofacial rhytidectomy is one of the most popular aesthetic surgical procedures. Injuries to the great auricular or buccal branch of the facial nerve have been reported, but morbidity is relatively low and sequelae are easily treated. A less common complication after facial/neck lift surgery is injury to the spinal accessory nerve. Disruption of this nerve, although uncommon, is associated with high morbidity and can cause severe pain, weakness of the shoulder, and aesthetically unpleasant deformities. Described landmarks focus on the nerve's course in the neck or are inconsistent.
Materials / method: To evaluate the course of the accessory nerve, 111 human cadavers were used. In these cadavers, 186 necks were dissected to fully expose the accessory nerve. Its surface point at the posterior sternocleidomastoid muscle was measured in relation to four easily palpable landmarks: the tip of the mastoid process, the sternoclavicular joint, the middle of the clavicle, and the acromioclavicular joint. The resulting values were used to define a 'danger zone' where the nerve was most likely to exit. A literature review was conducted to identify and analyze procedures for salvage.
Results: The distance of the surface point of the accessory nerve at the posterior sternocleidomastoid muscle averaged 5.1 cm (± 0.99 cm) from the tip of the mastoid, 11.0 cm (± 1.48 cm) from the sternoclavicular joint, 9.1 cm (± 1.24 cm) from the midpoint of the clavicle, and 12.8 cm (± 1.37 cm) from the acromioclavicular joint. A circular 6.9 cm2 'danger zone' with a radius of 1.48 cm could be defined. Rescue procedures followed standard nerve repair but also included intensive physical therapy.
Conclusion: The results of our study provide a reliable 'danger zone' that is easy to locate on the operating table and does not depend on patient positioning. Injury to the spinal accessory nerve is a rare but serious complication of facial rhytidectomy procedures. It is important to know the course of the nerve to minimize the risk of iatrogenic injury, and rescue procedures should be known.
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