Research Of Improvement Of Neck Function And Aesthetics Of Modified Curve Incision In Unilateral Neck Dissection

Objective By comparing the influence of adopting modified curve incision and conventional incision on neck function and aesthetics after unilateral neck dissection, we try to seek an ideal incision maximizing patients'quality of life after operations and to provide maxillofacial surgeons with theoretical evidences on choosing incisions in neck dissection.Methods Twenty return visit patients with maxillofacial malignant tumor to the department of stomatology, Xiangya Hospital, Central South University 6 months or more after unilateral neck dissection were selected,10 of which underwent modified curve incision and the other were of quasi-rectangular incision. Sensation loss, allodynia, scar and motion of faciocervical region were examined. Eight regions including lower ear, middle face, lower face, upper posterior neck, upper anterolateral neck, lower posterior neck, upper anterior neck and lower anterior neck regions. Skin of neck and bucca was examined to judge allodynia. To evaluate scar, Vancouver scar scale (VSS) was adopted, which includes 4 parameters--color, thickness, distribution of vessels and tenderness. To assess cervical motion, angles of laterofalexion and rotation to both unaffected and affected sides, anteflexion and extension were observed. Data collected were statistically analyzed.Results 1. Modified curve incision had 5 cases with sensation loss of cervical skin, the area concentrated in A.,D,E,F, while had 0 case of allodynia.; Quasi-rectangular incision had 6 cases with sensation loss of cervical skin, the area concentrated in A.,D,E,F, while had 0 case of allodynia. The variance was not statistically significant(P<0.05).2. Results of scar were expressed as means±SD.The mean value of scar was 3.30±1.42 in modified curve incision, the mean value of scar was 6.00±2.67 in quasi-rectangular incision. The variance was statistically significant(P<0.05).3. Results of the motion of the neck were also expressed as means±SD. The mean value of lateral flexion away from operated side was 23.32±2.87°in modified curve incision and 20.86±8.22°in quasi-rectangular incision. The mean value of lateral flexion to operated side was 26.36±2.11°in modified curve incision and 24.37±7.84°in quasi-rectangular incision. The mean value of rotation away from operated side was 61.29±6.69°in modified curve incision and 51.11±10.00°in quasi-rectangular incision. The mean value of rotation to operated side was 66.74±8.52°in modified curve incision and 64.76±9.89°in quasi-rectangular incision. The mean value of forward flexion was 45.59±12.57°in modified curve incision and 43.55±13.53 in quasi-rectangular incision. The mean value of extension was 38.27±3.06°in modified curve incision and 33.62±5.69°in quasi-rectangular incision. The items, including rotation away from operated side and extension were statistically significant(P<0.05), while others were not statistically significant(P>0.05).Conclusion 1. The sensation of the neck skin had no obvious difference between modified curve incision and quasi-rectangular incision. The loss of sensation was concentrated in A, D, E, F area.2. Modified curve incision resulted in less obvious scar and better aesthetic effects.3. Modified curve incision resulted in greater cervical motion.