A novel method of finding accessory nerve during head and neck surgery.

Introduction and purpose: In this prospective study, we performed neck morphological measurements and the relationship between the nerve and important anatomical structures in the neck to prevent spinal accessory nerve (SAN) damage in patients who underwent neck dissection.

Methods: This study was conducted prospectively between October 2021 and September 2023 in 80 patients who underwent neck dissection due to head and neck malignancy.

Results: The mean age of 59.2 ± 17.07 years (18-90 years) of the 80 patients, 54 were men and 26 were women. There was a positive correlation between the distance between the NAM-SAN and the sternocleidomastoid (Scm) muscle thickness(r = 0.242, p = 0.03). There was a positive correlation between the distance between the NAM-SAN and the distance between the mastoid apex and the clavicle midline (r = 0.235, p = 0.036). There was a statistically significant negative correlation between the distance between the NAM-SAN and age (r = - 0.324 p = 0.003). There was a positive correlation between the trapezius-SAN and the distance between the mandibula angulus-clavicle midline (r = -0.243 p = 0.03).

Conclusion: The spinal accessory nerve must be sought for higher than the estimated point In patients which with more scm thickness. It should be considered that as the preoperatively measured mastoid apex-clavicle distance increases, the distance between the NAM and the SAN increases. It should be taken into consideration that the course of the SAN in the posterior triangle will be longer in patients with longer necks. It should be noted that as age increases, the distance between the SAN and NAM decreases.