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Eur Arch Otorhinolaryngol. 2018 May;275(5):1227-1234. doi: 10.1007/s00405-018-4923-6. Epub 2018 Mar 5.

Inspiratory muscle weakness, diaphragm immobility and diaphragm atrophy after neck dissection.

Author information

1
Head and Neck Surgery and Otorhinolaryngology Department, AC Camargo Cancer Center, Rua Professor Antonio Prudente, 211, 01509-900, São Paulo, Brazil.
2
Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.
3
Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas das Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
4
Imaging Department, AC Camargo Cancer Center, São Paulo, SP, Brazil.
5
Head and Neck Surgery and Otorhinolaryngology Department, AC Camargo Cancer Center, Rua Professor Antonio Prudente, 211, 01509-900, São Paulo, Brazil. jgvartanian@uol.com.br.

Abstract

BACKGROUND:

Inspiratory strength after a neck dissection has not been evaluated, and diaphragm function has not been adequately evaluated.

OBJECTIVE:

Evaluate diaphragm mobility and inspiratory strength after neck dissection.

METHODS:

Prospective data collection of a consecutive series of adult patients submitted to neck dissection for head and neck cancer treatment, in a tertiary referral cancer center, from January to September 2014, with 30 days of follow-up. A total of 43 were studied (recruited 56; excluded 13).

MAIN OUTCOME MEASURES:

Determine diaphragm mobility and inspiratory muscle strength after neck dissection, using diaphragm ultrasound and by measuring maximal inspiratory pressure (MIP) and sniff nasal inspiratory pressure (SNIP).

RESULTS:

Thirty patients underwent unilateral neck dissection, and thirteen patients underwent bilateral neck dissection. Diaphragm immobility occurred in 8.9% of diaphragms at risk. For the entire cohort, inspiratory strength decreased immediately after the dissection but returned to preoperative values after 1 month. Except for those with diaphragm immobility, diaphragm mobility remained unchanged after the dissection. One month after the dissection, the diaphragm thickness decreased, indicating diaphragm atrophy.

CONCLUSIONS:

Immediately after a neck dissection, just a few patients showed diaphragmatic immobility, and there was a transient decrease in inspiratory strength in all individuals. Such findings can increase the risk of postoperative complications in patients with previous lung disease.

PMID:
29508056
DOI:
10.1007/s00405-018-4923-6
[Indexed for MEDLINE]

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