Practical Tips for Managing Cranial Nerves XI, XII, and Greater Auricular Nerve in Neck Dissection

Preservation of neurovascular structuresNeurovascular structures, preservation during cervical lymphadenectomyCervical lymphadenectomy is critical to preserve future function. A mixture of both spinal and cranial nerves is routinely encountered during the procedure. The greater auricular nerveGreater auricular nerve, which arises from the cervical plexus (C2, C3)Cervical plexus (C2, C3), provides sensory input to the skin over the parotid region, mastoid process, and portions of the ear, including the lobule. Cranial nerve XICranial nerve XI, the spinal accessory nerveSpinal accessory nerve, supplies the motor innervation to the sternocleidomastoid (SCM)Sternocleidomastoid (SCM) and trapezius musclesTrapezius muscles. Cranial nerve XIICranial nerve XII, the hypoglossal nerve, provides all the motor innervation to the intrinsic and extrinsic muscles of the tongue aside from the palatoglossusPalatoglossus. Each of these nerves provides critical patient functions that require preservation if feasible from an oncologic standpoint. A careful understanding of the course and its relationship to other vital structures is imperative to recognizing and preserving these structures during dissection. The purpose of this chapter is to review pearls and pitfalls in managing cranial nerves XI, XII, and greater auricular nerve in neck dissection.