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

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

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.

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Acknowledgements

The study was funded by FAPESP (Fundação de Amparo e Pesquisa do Estado de Sao Paulo). Grant Number: 2013/11835-6.

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Authors and Affiliations

  1. Head and Neck Surgery and Otorhinolaryngology Department, AC Camargo Cancer Center, Rua Professor Antonio Prudente, 211, 01509-900, São Paulo, Brazil

    Anne Flavia Silva Galindo Santana, Luiz Paulo Kowalski & Jose Guilherme Vartanian

  2. Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil

    Pedro Caruso & Pauliane Vieira Santana

  3. Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas das Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Pedro Caruso & Pauliane Vieira Santana

  4. Imaging Department, AC Camargo Cancer Center, São Paulo, SP, Brazil

    Gislaine Cristina Lopes Machado Porto

Authors
  1. Anne Flavia Silva Galindo Santana
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  2. Pedro Caruso
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  3. Pauliane Vieira Santana
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  4. Gislaine Cristina Lopes Machado Porto
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  5. Luiz Paulo Kowalski
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  6. Jose Guilherme Vartanian
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Corresponding author

Correspondence to Jose Guilherme Vartanian.

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Conflict of interest

Anne Flavia Silva Galindo Santana received a scholarship grant from “Capes” (a non-profit government agency) to participate in the study.All other authors have no conflict of interest with this manuscript.

Research involving human participants and or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Santana, A.F.S.G., Caruso, P., Santana, P.V. et al. Inspiratory muscle weakness, diaphragm immobility and diaphragm atrophy after neck dissection. Eur Arch Otorhinolaryngol 275, 1227–1234 (2018). https://doi.org/10.1007/s00405-018-4923-6

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  • DOI: https://doi.org/10.1007/s00405-018-4923-6

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