Accessory Spinal Nerve Injury

In 7 cases of peripheral lesion of the spinal accessory nerve 4 were produced by malignancy, two by iatrogenical resection of lymph nodes, one by an en bloc dissection of the neck for arteriovenous malformation. Incapacity following the injury is quite marked and includes weakness of the sternomastoid and trapezius muscles, as well as pain presumably from traction on the brachial plexus. The importance of avoiding the nerve in surgical intervention in the neck must be strongly emphasized. A review of the literature suggests that in fresh injuries the spinal accessory nerve should be explored and resutured. Our own experience, however, with nerve repair has been disappointing.