Balancing cancer treatment and quality of life in oral cancer surgery.

Preserving Hope and Function: Nerve and Vein Preservation in Oral Cancer Surgery

Lena Kashyap in Health & Wellness November 2025 • 5 min read.

"A comprehensive look at how modern surgical techniques balance cancer treatment with quality of life."

Oral cancer, a significant subset of head and neck cancers, often necessitates complex surgical interventions. Historically, radical neck dissections, while effective in removing cancerous tissue, could lead to significant functional impairments due to the sacrifice of nerves and blood vessels. Modern surgical oncology has increasingly focused on function-preserving techniques, aiming to minimize these side effects without compromising oncological outcomes.

Among these techniques, modified radical neck dissections (MND), particularly Type II, have gained popularity. MND Type II involves preserving the spinal accessory nerve (SAN) and the internal jugular vein (IJV), structures crucial for shoulder function and venous drainage of the brain, respectively. The rationale is clear: maintaining these structures can lead to better postoperative quality of life. However, the critical question remains: How effective are these nerve and vein-sparing techniques in the long run?

A recent study published in Acta Otorhinolaryngologica Italica sought to answer this question by prospectively evaluating patients undergoing nerve and vein-sparing neck dissections for oral cancers. The study meticulously assessed spinal accessory nerve function and internal jugular vein patency following treatment, providing valuable insights into the delicate balance between cancer control and functional preservation. Understanding the outcomes of such studies is vital for patients, their families, and healthcare professionals alike, ensuring informed decisions about treatment strategies.

What Does Nerve and Vein Preservation Actually Mean for Patients?

Balancing cancer treatment and quality of life in oral cancer surgery.

The primary goal of nerve and vein preservation during oral cancer surgery is to reduce long-term complications. When the spinal accessory nerve is preserved, patients are more likely to maintain good shoulder function, avoiding the pain and limited mobility that can result from nerve damage. Similarly, preserving the internal jugular vein helps ensure proper blood flow, reducing the risk of swelling, headaches, and other circulatory issues.

The study published in Acta Otorhinolaryngologica Italica provides a detailed look at the effects of these preservation techniques. Researchers followed 65 patients who underwent modified neck dissections (MND Type II) for oral squamous cell carcinoma. They used nerve conduction studies and Doppler ultrasound to assess nerve function and vein patency at baseline, one month post-surgery, and six months post-surgery. Arm abduction tests and quality of life questionnaires were also administered to gauge functional outcomes and patient satisfaction.

Key findings from the study included:

Nerve Dysfunction: There was a statistically significant increase in the latency (delay) of motor action potentials and a decrease in the amplitude (strength) of these potentials after surgery. This suggests that even with nerve preservation, some degree of nerve dysfunction is common.
Vein Patency: Post-surgery, there was a significant decrease in the diameter of the internal jugular vein, accompanied by an increase in blood flow velocity. While most patients maintained adequate vein patency, a small percentage (5%) experienced partial thrombus formation.
Functional Impact: Despite nerve dysfunction, shoulder abduction (raising the arm) was only moderately affected. The quality of life assessment showed a slight decrease in overall satisfaction, but this did not always translate into significant clinical impact.

These results underscore a crucial point: while nerve and vein preservation aims to minimize complications, some degree of dysfunction is almost inevitable. However, the body's ability to compensate, along with targeted rehabilitation, often mitigates the clinical impact of these changes. Furthermore, the risk of vein thrombosis, while present, appears to be relatively low with meticulous surgical technique.

Balancing Act: Weighing the Benefits and Risks

The decision to pursue nerve and vein-sparing techniques in oral cancer surgery is a complex one, requiring careful consideration of individual patient factors, tumor characteristics, and the surgeon's expertise. While these techniques offer the potential for improved quality of life, they must never compromise the primary goal of cancer control. Ongoing research and technological advancements continue to refine these procedures, striving for the optimal balance between oncological efficacy and functional preservation. If you or a loved one are facing oral cancer surgery, discuss these options thoroughly with your healthcare team to make informed decisions that align with your values and priorities.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.14639/0392-100x-1481, Alternate LINK

Title: Nerve And Vein Preserving Neck Dissections For Oral Cancers: A Prospective Evaluation Of Spinal Accessory Nerve Function And Internal Jugular Vein Patency Following Treatment

Subject: Otorhinolaryngology

Journal: Acta Otorhinolaryngologica Italica

Publisher: Pacini Editore

Authors: G.R. Kumar Reddy, N. Hulikal, A.Y. Lakshmi, B. Vengamma

Published: 2018-02-01

Everything You Need To Know

What does it mean for patients to have nerve and vein preservation during oral cancer surgery?

Nerve and vein preservation in oral cancer surgery aims to minimize long-term complications. Preserving the spinal accessory nerve (SAN) helps patients maintain shoulder function, avoiding pain and limited mobility. Preserving the internal jugular vein (IJV) ensures proper blood flow, reducing the risk of swelling and headaches. A study in *Acta Otorhinolaryngologica Italica* followed patients undergoing modified neck dissections (MND Type II) and assessed nerve function and vein patency using nerve conduction studies and Doppler ultrasound.

What specific nerves and veins are typically preserved in a Modified Radical Neck Dissection (MND) Type II, and why are they important?

Modified radical neck dissection (MND) Type II preserves the spinal accessory nerve (SAN) and the internal jugular vein (IJV). The spinal accessory nerve is crucial for shoulder function, and preserving it helps patients maintain good shoulder mobility and reduce pain after surgery. The internal jugular vein is essential for venous drainage of the brain, and its preservation reduces the risk of swelling, headaches, and other circulatory issues. This approach seeks to balance effective cancer treatment with the patient's quality of life.

What were the main findings of the study published in Acta Otorhinolaryngologica Italica regarding nerve and vein preservation in oral cancer surgery, and what implications do these findings have?

The study in *Acta Otorhinolaryngologica Italica* found that even with nerve preservation, some degree of nerve dysfunction is common, as indicated by increased latency and decreased amplitude of motor action potentials. While most patients maintained adequate vein patency, a small percentage experienced partial thrombus formation. Despite these issues, shoulder abduction was only moderately affected, and quality of life assessments showed a slight decrease in overall satisfaction that didn't always translate into significant clinical impact. Rehabilitation and the body's ability to compensate play crucial roles in mitigating the impact of these changes.

How is the decision made to pursue nerve and vein-sparing techniques in oral cancer surgery, and what factors are considered to ensure effective cancer treatment?

While nerve and vein-sparing techniques like modified radical neck dissection (MND) Type II aim to improve quality of life, the primary goal remains cancer control. Surgeons must carefully consider individual patient factors, tumor characteristics, and their own expertise to determine the best approach. If nerve or vein preservation compromises the removal of cancerous tissue, it may not be the appropriate choice. Ongoing research and technological advancements are continually refining these procedures to optimize the balance between oncological efficacy and functional preservation.

Besides the spinal accessory nerve (SAN) and the internal jugular vein (IJV), are there other nerves and veins that surgeons consider preserving during oral cancer surgery, and why are they important?

While the study focused on the spinal accessory nerve (SAN) and the internal jugular vein (IJV) in modified neck dissections (MND), other nerves and veins in the head and neck region are also considered during oral cancer surgery. For example, preserving branches of the facial nerve is crucial to maintain facial expression and function. Similarly, preserving other major veins helps maintain adequate blood flow and prevent complications. The specific nerves and veins considered for preservation depend on the location and extent of the tumor, as well as the surgical approach.