Conditions: Frozen Neck
Injury to nearby structures is a risk for any surgical procedure. When it comes to nose and sinus surgery, the nearby structures include the boundary between the nose and the cranial vault. Injury to the skull base is discussed here.
WHAT is frozen neck?
Frozen neck refers to a condition where the neck muscles become rigid and restricted in their range of motion or completely immobile. Frozen neck can be the result of various factors, including muscle strain, a herniated cervical spine disk, or development of severe scar tissue in the soft tissues of the neck. Individuals with frozen neck may need to turn their torso or whole body in order to shift their gaze. This may be cumbersome or sometimes impossible, creating a safety risk with driving, walking, or any other physical activity. Additionally, frozen neck can be uncomfortable. Although some causes of frozen neck, such as those due to muscle pain, are reversible, a frozen neck resulting from scar tissue formation is typically permanent. For this reason, prevention is essential.
Neck cancer and frozen neck
Treatment of head and neck cancer can lead to frozen neck. This is primarily a risk when a patient undergoes both chemotherapy and radiation therapy concurrently, but can also occur after radiation alone. Surgery alone rarely causes a frozen neck, but radiation before or after radiation therapy (with or without chemotherapy) adds to the risk.
The reason for this timeline is biological. Treatment for cancer creates a wound. This may be thought of as collateral damage since the ideal cancer treatment would remove every cancer cell and leave the normal cells completely unaltered. Despite major advances in minimizing side effects of cancer treatment, current therapy, whether by surgery, radiation, chemotherapy, or a combination of these, does still create a wound. With this wound, comes inflammation, followed in a few days by a healing response where collagen (scar) forming cells called fibroblasts migrate into the affected tissues. By 2 to 4 weeks, the fibroblasts are maximally productive in producing collagen, the material of which scar is made. These collagen scar fibers lack the ability to stretch. The scar then contracts and hardens in a process that continues for approximately six months after the wound. This slow, sneaky, and unrelenting process occurs in the skin, muscle, blood vessels, and inner lining of the mouth, throat, and neck during a time when many patients are attempting to rest and recover from their treatment.
Development of frozen neck during and after treatment for head and neck cancer is deceptively dangerous. It has a slow, subtle and initially painless onset. It tends to occur while a patient is mentally and physically recovering from treatment, which is when the individual is distracted by other aspects of their recovery and not necessarily vigilant or energetic enough to proactively identify and treat the problem. There is only a limited window of opportunity to prevent or reverse this scar tissue formation, however, and once the scar tissue has developed, it may be impossible to fix the problem. This is why it is dangerous.
how can frozen neck be prevented?
Frozen neck CAN be prevented, but it requires proactive effort. Prevention of frozen neck is an example of the use it or loose it concept, where “it” is the range of motion in the neck. This basically comes down to stretching exercises and avoidance of keeping the neck in the same position for a long time. Physical therapy is a major help in assessing for decreased neck range of motion and for providing exercises to correct the problem and minimize progression. Physical therapy is often very helpful after treatment for head and neck cancer for other related conditions, such as lockjaw (trismus) and shoulder weakness, and so neck exercises can be incorporated into an overall plan by the physical therapist.
how can frozen neck be treated?
The treatment is prevention. Once frozen neck has set in with stiff and tight scar tissue, the treatment options are severely limited.