Head and Neck Oncology

Systematic review

Medical & Radiation Oncology

Guilleré L, Wagner I, Bequignon E, Blumen M, Chabolle F, Bach CA. Neuromuscular injuries after neck surgery and radiotherapy for cancer: A systematic literature review. Head Neck Oncol 2014 Aug 18;6(4):36.

Abstract

Background

Treatment of head and neck cancer allows patient survival, but remains aggressive, mutilating and a source of severe sequelae. Certain treatment sequelae have been clearly documented, while little is known about neuromuscular injuries. The purpose of this study, based on a systematic review of the literature, was to determine the neuromuscular injuries secondary to treatment of head and neck cancer by surgery and/or radiotherapy and to define the incidence of these injuries.

Methods

A comprehensive literature search for neuromuscular injury after head and neck surgery and radiotherapy spanning from 1947 to 2013 was performed on several databases (Medline, Embase, Cochrane). This review focuses on nerve injury, muscle injury, and functional outcome after head and neck surgery and/or radiotherapy for head and neck cancer.

Results

The publications reviewed consisted of 66 retrospective studies (including 18 clinical case reports) and 28 prospective studies. The median number of patients per series was 44 (range: 1 to 1,652).

Discussion

This review demonstrated that it is impossible to define the incidence of neuromuscular injuries induced by surgery and radiotherapy for head and neck cancer. Levels of evidence were low, descriptions and analyses were incomplete, patient groups were heterogeneous, and the scopes of the studies were too disparate. Easily demonstrated complications such as spinal accessory nerve injuries occupy a predominant place in the literature. Further research is required on other nerve and muscle injuries that remain poorly defined. Despite these gaps in our knowledge, the treatment sequelae can no longer be ignored or neglected. Although effective treatments are not always available, prevention, detection, rehabilitation, and management of these injuries must be an integral part of patient care.

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