The phrenic nerve; the forgotten nerve in head and neck surgery.
Level 4 - case-series / case-control
Systematic review of observational case series and cohort studies
PubMed 36792555 · doi:10.1111/ans.18322
What was done
A systematic literature review was conducted covering studies published between 2000 and 2022 to evaluate the incidence of phrenic nerve paresis following neck dissection for head and neck malignancy.
What was found
Eleven studies were included. The reported immediate post-operative phrenic nerve paresis rate ranged from 0% to 5.3%, with an overall average rate of 0.613% (12/1959). At follow-up (ranging from 1 month to 127 months), the reported rate ranged from 0% to 4.7%, with an average rate of 1.035% (5/483). No cases of bilateral phrenic nerve paresis were reported.
Why it matters
Phrenic nerve paresis is an uncommon complication of neck dissection that is frequently asymptomatic and likely underreported. Knowledge of its incidence reinforces the importance of maintaining dissection superficial to the prevertebral fascia over the anterior scalene muscle.
Limits
The review included only 11 studies with significant heterogeneity in follow-up duration (1 to 127 months) and large attrition between immediate (1,959 patients) and follow-up (483 patients) cohorts. Because paresis is often asymptomatic and routine postoperative monitoring is rare, true rates may be underdetected.
Cited by
- supports The phrenic nerve is the nerve that controls the diaphragm.