IN THE past 12 months I examined six patients who had injuries to the accessory nerve secondary to minor surgical procedures carried out in the posterior cervical triangle. In only two of the six patients did the referring physician recognize the existing trapezius paralysis or appreciate how disabling this paralysis may be. As pointed out by Norden,1 Wulff,2 and Hanford,3 the accessory nerve is extremely vulnerable to injury, since it traverses the posterior cervical triangle from the posterior edge of the sternomastoid muscle to its entrance into the superior edge of the trapezius. The nerve trunk is small and lies rather superficially beneath the skin. The operator rarely recognizes that it has been injured in the course of minor surgical procedures.
It is probable that this complication occurs much more frequently than seems apparent by perusal of the surgical literature. Norden reported 16 cases in which paresis