Background: The spinal accessory nerve (SAN) plays a crucial role in shoulder function by innervating the trapezius and sternocleidomastoid muscles. Its injury during neck dissection can lead to significant postoperative morbidity, including shoulder dysfunction. While various anatomical landmarks have been described for locating the SAN, these can be unreliable, particularly in the presence of metastatic lymphadenopathy. Objective: To present a novel and consistent technique for identifying the SAN during neck dissection using fixed anatomical landmarks. Methods: A prospective observational study was conducted on 27 patients undergoing functional or modified radical neck dissections. An imaginary line was drawn from the body of the hyoid bone to the anterior border of the sternocleidomastoid muscle. Dissection was focused along this path to identify the SAN in level 2 of the neck anterior to sternocleidomastoid muscle. Results: The SAN was successfully located in all patients using this method, regardless of age, gender, or the presence of bulky nodal disease. The use of the hyoid bone as a fixed bony landmark provided a reliable reference point, reducing the need for deep or risky dissections. Conclusion: This innovative technique provides a simple, reproducible method for early identification and preservation of the SAN during neck dissection, especially in challenging anterior triangle scenarios. It holds potential for widespread adoption in surgical practice to enhance patient outcomes.
