What is the role of biopsy in the treatment of spinal accessory nerve (SAN) injury?

Updated: Mar 04, 2020
  • Author: Rohan R Walvekar, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Performing a diagnostic biopsy on lymph nodes in the posterior triangle is controversial. Most isolated enlarged lymph nodes in young, healthy patients are reactive in nature. Even in established cases of head and neck cancer, only a small percentage of patients present with isolated metastasis to the posterior triangle. [59] Observation or fine-needle aspiration biopsy for persistent lymphadenopathy is reasonable. However, noting that persistent lymphadenopathy may represent relevant pathology such as lymphoma is important. The authors have found diagnostic lymph node biopsies to be very useful in our experience.

The surgeon performing a neck node biopsy must explain to the patient the potential for SAN paresis or palsy. Loupe magnification and bipolar coagulation have been recommended as the standard of care while performing surgery on neck nodes. [54] However, the importance of good surgical technique, knowledge of surgical landmarks, and relevant anatomic variations of the SAN cannot be overemphasized.

A study by Lanišnik et al indicated that intraoperative nerve monitoring of the SAN during modified radical neck dissection can lead to reduced postoperative shoulder disability, benefiting surgeons at the start of their learning curve and as they become familiar with the anatomical variation of the SAN. In the study, patients undergoing the dissection procedure were monitored on one side of the neck but not on the other, with the trapezius muscle demonstrating better EMG scores at 6 months postoperatively on the monitored sides than on the unmonitored sides. [63, 64, 65]

In the authors’ experience, indications for cervical lymph node biopsy include persistent lymphadenopathy after a trial of antibiotics, persistent lymphadenopathy associated with an inconclusive fine-needle aspirate, or the presence of risk factors for head and neck cancer or lymphoma. [14]

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