A nerve injured in radical neck dissection leads to loss of sensation in medial side of the arm, nerve injured is?
ANSWER: (D) Medial cutaneous nerve of armREF: Schwartz 9th ed chapter 18, Bailey 25th ed page 733, Mastery of Surgery, Volume 1 edited by Josef E. Fischer, Kirby I. Bland, Mark P. Callery 5th ed Vol 1 page 323Virtually any part of brachial plexus can be injured in RND. Read following lines of Gray's anatomy.The medial cutaneous nerve of the arm is the smallest and most medial branch of the brachial plexus, and arises from the medial cord (C8, Tl). It crosses the axilla, either anterior or posterior to the axillary vein, then passes medial to the axillary vein, communicates with the intercostobrachial nerve, and descends medial to the brachial artery and basilic vein. It pierces the deep fascia at the midpoint of the upper arm to supply the skin over the medial aspect of the distal third of the upper arm. (Gray's anatomy 40th ed chapter 46)Safety or Holy layer; the layer of prevertebral fascia that covers the brachial plexus and phrenic nerve. It is advisable to stay superficial to this layer in order to avoid damage to these vital structures (Ref: Step by step Neck dissection Dr Chintamani page 5)MASTERY OF SURGERY 5TH ED VOL 1 TABLE 6 PAGE 323TYPES OF NECK DISSECTIONSDissectionLymph Node Levels RemovedNon nodal Structures RemovedIndicationsComprehensive neck dissectionsRadical/ Classical/ Crile {RND)Levels I-VSpinal accessory nerve (SAN) Internal jugular vein (IJV) Sternocleidomastoid muscle (SCM)Submandibular glandNr neck for SCC when SAN is involvedMRND type 1Levels I-VPreserves SANN+ neck for SCC when SAN is free (most commonly used for SCC of upper aerodigestive tract)MRND type 2Levels I-VPreserves SAN & SCMN+ neck for SCC when LA7 is involved but SAN is freeMRND type 3Levels I-VPreserves SAN, IJV & SCMMost commonly used for metastatic Ca of thyroidSelective neck dissectionsSupraomohyoidLevel I- IIIPreserves SAN, IJV & SCMN-ve neck SCC of oral cavity and oropharynx N-ve neck malignant melanoma anterior to earExtendedsupraomohyoidLevel I- IVPreserves SAN, IJV & SCMN-ve neck SCC of lateral tongueLateral NDLevel II- IVPreserves SAN, IJV & SCMN-ve neck SCC of Larynd & HypopharynxPosterioLateral NDLevel II- V,Suboccipital,RetroauricularPreserves SAN, IJV & SCMN-ve neck malignantmelanoma posterior to earNote:Structure preserved in RND: ICA, EC A (may be sacrificed), Brachial plexus, Hypoglossal nerve, Vagus nerve, Phrenic nerve, Facial nerve (cervical and marginal mandibular branches), Sympathetic trunkCommonest incisions in RND:Crile's incision (modified Y incision)Macfees incision (double horizontal incision) in irradiated neck.The main disability that follows the RND is weakness and drooping of the shoulder due to paralysis of the trapezius muscle as a consequence of excision of the spinal accessory nerve.
Long thoracic nerve
Thoracodorsal nerve
Dorsal scapular nerve
Medial cutaneous nerve of arm
Orthopedics