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Case report
Dual spinal accessory nerve: caution during neck dissection
  1. Muhammad Hassan Danish,
  2. Haissan Iftikhar and
  3. Mubasher Ikram
  1. Surgery, Aga Khan University, Karachi, Sindh, Pakistan
  1. Correspondence to Dr Haissan Iftikhar; haissaniftikhar{at}


Preserving the spinal accessory nerve (SAN) is an important step in the modern-day neck dissection to avoid postoperative functional morbidity in patients. This goal can become technically difficult, especially, when rare anatomical variations are encountered. We present a case of dual SAN in a patient undergoing selective neck dissection for oral squamous cell carcinoma. Both SANs were preserved and patient had no shoulder dysfunction postoperatively. We take this opportunity to emphasise that meticulous dissection is the only proven way to preserve the nerve. And that surgeons should be aware of this anatomical variation. SAN should be subjected to minimal traction during neck dissection to avoid tension neuropraxia and long-term shoulder dysfunction.

  • head and neck cancer
  • ear, nose and throat/otolaryngology

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  • Contributors MHD contributed to manuscript writing. HI contributed to planning and review. MI contributed to review and supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.