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Video

Head and Neck Surgery

(A524) Classifications of Shoulder Dysfunction Post-Neck Dissection in Head and Neck Cancer

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Javier Aguirre Ayala

    Medical Student
    The University of Oklahoma College of Medicine
    Oklahoma City, Oklahoma, United States

    • Co-Author(s)

  • RN

    Rachel L. Neuhold, Other

    Physical Therapist and Board Certified Oncology Specialist
    OU Health Stephenson Cancer Center, United States

  • RP

    Rusha J. Patel, MD

    Associate Professor
    University of Oklahoma Health Sciences Center
    Oklahoma City, Oklahoma, United States

    • Senior Author(s)

  • Greg A. Krempl, MD

    Professor and Chairman
    Department of Otolaryngology - Head and Neck Surgery, The University of Oklahoma College of Medicine
    Oklahoma City, Oklahoma, United States

Disclosure(s):
Javier Aguirre Ayala: No relevant relationships to disclose.
Rusha J. Patel, MD: No relevant relationships to disclose.
Greg A. Krempl, MD: No relevant relationships to disclose.


Introduction: Surgical neck dissections (ND) for the treatment of head and neck cancer can result in spinal accessory nerve palsy (SANP), causing significant shoulder dysfunction; varied assessment methods complicate prevalence estimates. This study evaluates SANP prevalence by comparing pre- and post-operative shoulder function and introduces a novel SANP classification system.

Methods: This retrospective study assessed 25 patients with head and neck cancer undergoing ND from November 2022 at an NCI-Designated Cancer Center. Shoulder function was evaluated pre- and post-operatively using active range of motion with a goniometer, scapular flip sign test (SFS), pain levels, and trapezius strength via manual muscle testing. Cranial nerve XI dysfunction was diagnosed by SFS positivity and trapezius weakness. Demographic and surgical data were analyzed to identify SANP phenotypes.

Results: Among 29 shoulders from 25 patients, SANP was identified in 75.86% (22/29). Unilateral ND patients exhibited SANP in 85.71% (18/21) of cases, while 50% (4/8) of bilateral ND patients showed SANP. Of those who had selective ND, 73.68% (15/19) had SANP. SANP caused significant functional declines, including a mean 34.3° loss in flexion and 52.75° in abduction. Notably, 54.5% (12/22) of shoulders with SANP failed to achieve >90° abduction, and all exhibited pain and trapezius weakness. Additionally, 27.27% (6/22) of shoulders with positive flip signs were in patients who reported no pain, and 31.81% (7/22) had decreased trapezius strength without pain. Phenotype analysis revealed three categories: (1) pain with abduction < 90°, (2) pain with abduction >90°, and (3) painless with positive SFS and trapezius weakness.

Conclusions: This study identifies a higher-than-reported prevalence of SANP following ND and introduces a novel SANP classification system based on pain, ROM, and trapezius function. These phenotypes enable targeted rehabilitation strategies to improve outcomes and support further research into post-ND care.