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Neck dissection

  • Definition
    • Neck dissection is surgery to remove the lymph nodes in the neck.

  • Alternative Names
    • Radical neck dissection; Modified radical neck dissection; Selective neck dissection; Lymph node removal - neck

  • Description
    • Neck dissection is a major surgery done to remove lymph nodes that contain cancer. It is done in the hospital. Before surgery, you will receive general anesthesia. This will make you sleep and unable to feel pain.

      The amount of tissue and the number of lymph nodes that are removed depend on how far the cancer has spread. There are three main types of neck dissection surgery:

      • Radical neck dissection: All the tissue on the side of the neck from the jawbone to the collarbone is removed. The muscle, nerve, salivary gland, and major blood vessel in this area are all removed.
      • Modified radical neck dissection: This is the most common type of neck dissection. All lymph nodes are removed. Less neck tissue is taken out than with radical dissection. This surgery may also spare the nerves in the neck and, sometimes, the blood vessels or muscle.
      • Selective neck dissection: If cancer has not spread far, fewer lymph nodes have to be removed. The muscle, nerve, and blood vessel in the neck may also be saved.
  • Why the Procedure is Performed
    • The lymph system carries white blood cells around the body to fight infection. Cancer cells in the mouth or throat can travel in the lymph fluid and get trapped in the lymph nodes. The lymph nodes are removed to prevent cancer from spreading to other parts of the body and to decide if any more treatment is needed.

      Your doctor may recommend this procedure if:

      • You have cancer of the mouth, tongue, thyroid gland, or other areas of the throat or neck.
      • Cancer has spread to the lymph nodes.
      • The cancer could spread to other parts of the body.
  • Risks
    • Risks for anesthesia and surgery in general are:

      • Allergic reactions to medicines
      • Breathing problems
      • Bleeding
      • Infection

      Other risks for this surgery are:

      • Numbness in the skin and ear on the side of the surgery, which may be permanent
      • Damage to the nerves of the lip and tongue
      • Problems lifting the shoulder and arm
      • Limited neck movement
      • Drooping shoulder on the side of the surgery
      • Problems talking or swallowing
  • Before the Procedure
    • Always tell your health care provider:

      • If you are or could be pregnant
      • What medicines you are taking, including those you bought without a prescription. This includes vitamins, herbs, and supplements.
      • If you have been drinking a lot of alcohol, more than 1 or 2 drinks a day

      During the days before your surgery:

      • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
      • Ask your doctor which medicines you should still take on the day of your surgery.
      • You will be told when to arrive at the hospital.

      On the day of your surgery:

      • You will be asked not to drink or eat anything after midnight the night before your surgery.
      • Take any approved medicines with a small sip of water.
  • After the Procedure
    • You will be taken to the recovery room to wake up after surgery.

      • The head of your bed will be raised at a slight angle.
      • You will have a tube in a vein (IV) for fluids and nutrition. You may not be able to eat or drink for the first 24 hours.
      • You will get pain medicine and antibiotics.
      • You will have drains in your neck.

      The nurses will help you get out of bed and move around a little on the day of the surgery. You may start physical therapy while you are in the hospital and after you go home.

      Most people go home from the hospital in 2 to 3 days. You will need to see your doctor for a follow-up visit in 7 to 10 days.

  • Outlook (Prognosis)
    • Healing time depends on how much tissue was removed.

  • References
    • Robbins KT, Samant S, Ronen O. Neck Dissection. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 121.