Marginal mandibular nerve injury during neck dissection and its impact on patient perception of appearance

Background. Neck dissection to remove cervical lymph nodes is common practice in head and neck cancer management. The marginal mandibular nerve may be injured during neck dissection, particularly of level 1. The rate of injury to this nerve is underreported in the literature and its impact on patients is not well defined. Methods. An observational study was undertaken on patients who had undergone neck dissection over a 5-year period. The patients were examined for weakness and given a questionnaire related their perception of their appearance and their function. Results. Sixty-six patients were identified who had undergone 85 neck dissections. The rate of House Brackmann injury was 18% when analyzed by patient and 23% by neck. There were moderate correlations between observed injury and subjective responses to questions relating to ability to smile and weakness of the lower lip. Discussion. The rate of smile asymmetry following neck dissection is relatively high; however, severe injuries to the marginal mandibular nerve are uncommon