What is Neck Dissection

Neck dissection is surgery to remove lymph nodes and other structures in the neck that may have become cancerous (malignant).

This surgery may be done for a person who has head or neck cancer or other cancers that may have spread to the lymph nodes. The goal of the surgery is to remove the cancer cells and prevent the cancer from spreading to other parts of the body.

Lymph nodes are oval-shaped organs that help to filter toxins and dead cells from the body. Lymph nodes are linked through a network of lymph vessels. The lymph nodes in the neck are usually the first place that cancer of the head or neck may spread. From the lymph nodes, cancer cells can spread through the lymph vessels to other parts of the body.

Neck dissection surgery will vary depending on the areas of the neck that are involved, as well as the amount of lymph nodes and other structures that need to be removed. The three most common types of neck dissection are:

• Radical neck dissection. All of the lymph nodes are removed as well as other structures in the area, including muscle (sternocleidomastoid muscle), veins (jugular vein), and nerves (spinal accessory nerve).
• Modified radical neck dissection. All of the lymph nodes are removed, but the other structures are usually not removed.
• Selective neck dissection. Only some of the lymph nodes in the area are removed.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or anesthetics.
• Damage to other structures or organs.
• Difficulty talking, swallowing, or moving your tongue.
• Facial swelling.
• Trouble raising your arm.
• Numbness, weakness, or loss of function in your face, tongue, neck, throat, or shoulder. This may be temporary or permanent.

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may have an exam or testing.
• You may have a blood sample taken.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins. You will receive fluids and medicines through this tube during and after the procedure.
• You will be given a medicine that makes you fall asleep (general anesthetic).
• After you are asleep, the surgeon will make an incision on one side of your neck, from just above your collarbone to just below your jawbone. Other smaller incisions may also be needed.
• Muscles that do not need to be removed will be carefully moved aside. Care will be taken to protect your nerves and blood vessels during the procedure.
• The lymph nodes and other targeted structures will be removed. The amount of tissue and structures that are removed will depend on the type of neck dissection that is being done.
• One or more plastic drains may be inserted at the bottom of your neck. If this is done, suction bulbs will be attached to catch the excess blood and other fluids that will drain from your incision after the procedure.
• The surgeon will close the incision with stitches (sutures) or staples.
• A bandage (dressing) will be placed over the incision and the drains.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You will be given pain medicine as needed.
• The head of your bed will be raised (elevated) to help reduce swelling.
• Your IV tube will likely be removed when you are able to drink fluids.
• Your diet will be increased gradually.
• Your speech and swallowing will be observed closely.
• If you have drains in place, these may stay in place for several days or until no more fluid is draining. If you go home with the drains still in place, you will be shown how to take care of them at home.

Neck Dissection, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain or soreness.
• Stiffness in your neck or shoulder.
• Burning or tingling sensations.
• Weakness or numbness if any nerves or muscles were removed.

Follow these instructions at home:

Incision care

• There are many ways to close and cover a cut (incision). For example, an incision can be closed with stitches (sutures), skin glue, or adhesive strips. Follow instructions from your health care provider about:
  • How to take care of your incision.
  • When and how you should change your bandage (dressing).
  • When you should remove your dressing.
  • Removing whatever was used to close your incision.
• Check your incision area every day for signs of infection. Watch for:
  • Redness, swelling, or pain.
  • Fluid, blood, or pus.
• If you have drainage tubes, follow instructions from your health care provider about how to care for them.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If your health care provider approves bathing and showering, cover the bandage with a watertight plastic bag to protect it from water. Do not let the bandage get wet.
• Keep the dressing dry until your health care provider says it can be removed.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything that is heavier than 10 lb (4.5 kg).
• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Exercise only as told by your health care provider or physical therapist. Do not exercise this area until your health care provider approves. If muscles or nerves were removed during your procedure, your health care provider may recommend certain exercises to help you regain some of the motion in your upper body.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Try eating soft foods for a while after the procedure. This can help to minimize pain if your throat is sore or if you have difficulty swallowing.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have pain that is not relieved by pain medicine.
• Your neck or shoulder gets weaker or stiffer.
• You have a fever.
• You have redness, swelling, or pain at the site of your incision.
• You have fluid, blood, or pus coming from your incision.

Get help right away if:

• Your drain comes out or gets blocked.
• You have difficulty breathing.
• Your incision starts to open.