Neck Dissection

What is neck dissection?

Neck dissection is surgery that removes lymph nodes in your neck (cervical lymph nodes) to check for cancer. Your lymph nodes are small organs throughout your body that filter substances from a fluid called lymph. Lymph drains from your body’s cells and tissues. If you have cancer, the cancer cells can travel in lymph and get trapped in nearby lymph nodes.

Healthcare providers perform neck dissections to see if head and neck cancers, thyroid cancer or skin cancer has spread to your cervical lymph nodes. This information helps your provider stage the cancer, or determine how advanced it is.

Neck dissection may also be a part of treatment. Removing cancerous lymph nodes during diagnosis prevents the cancer from spreading. It reduces the chance you’ll need separate surgeries for treatment. Sometimes, it keeps you from needing other treatments like radiation and chemotherapy.

How should I prepare for this procedure?

Neck dissection is a major operation, and this means there’s lots of preparation involved. Your healthcare provider will give you instructions, so you know exactly what to do. But you should still ask any questions you have.

Before your procedure, you should know:

• What behaviors you need to adjust beforehand (including smoking and alcohol consumption)
• If (and when) you’ll need to stop taking certain medications, herbs or supplements
• When you should stop eating and drinking before the procedure
• What you should and shouldn’t wear (including jewelry, deodorants and creams)
• What to pack to prepare for staying in the hospital overnight
• How much time you’ll likely need to take off work
• How much caregiving support you’ll need from loved ones during recovery

What happens during neck dissection?

You’ll be in a hospital operating room for the procedure. First, you’ll receive general anesthesia that puts you to sleep and a breathing tube. For the actual procedure, your surgeon will remove lymph nodes on the left side of your neck, the right side or both sides. They may need to remove additional structures in your neck to access these lymph nodes.

What happens during the procedure depends on the type of neck dissection:

• Radical neck dissection. Your surgeon removes all lymph nodes from the affected side of your neck. They also remove your spinal accessory nerve (helps with arm movements), sternocleidomastoid (SCM) muscle (helps with head and neck movements) and internal jugular vein (drains blood).
• Extended radical neck dissection. A surgeon performs a radical neck dissection but also removes additional nerves, blood vessels or muscles.
• Modified radical neck dissection. This procedure is like a radical neck dissection. But your surgeon spares one or more neck structures (spinal accessory nerve, SCM muscle or your internal jugular vein).
• Selective neck dissection. Your surgeon only removes lymph nodes where cancer is most likely to spread.

Afterward, your surgeon will insert one or more drains that draw fluid away from the wound. The drains will help it heal faster. Then, your surgeon will seal the incision site with stitches or staples.

In the meantime, they’ll send the lymph nodes to a lab to test for cancer cells (lymph node biopsy). Most people receive their results within a week or two.

How long does this procedure take?

A radical neck dissection may take from two to four hours. It may take longer depending on your situation. For example, if you have thyroid cancer and your provider is removing your thyroid at the same time as your lymph nodes, your total time in the operating room will be longer.

Your provider can explain how long surgery will likely take based on the type of neck dissection and other procedures you may need.

What are the potential benefits and risks of neck dissection?

Healthcare providers only recommend neck dissections when the benefits greatly outweigh the risks. Neck dissection can provide information about your diagnosis that helps your provider choose the most effective treatments. It also allows your provider to treat cancer by removing cancerous tissue.

But as with any surgery, complications can happen. They include risks common to all surgeries, like bleeding, infections and reactions to anesthesia. Complications unique to neck dissection mostly involve damage to nerves in your face and neck. They include:

• Permanent or temporary numbness at the surgery site
• Trouble swallowing, eating or speaking
• A drooping face on the side where surgery was done
• A drooping shoulder or trouble lifting your shoulder on the surgery side

Keep in mind that the risks vary depending on the type of neck dissection. Frequently, complications are temporary or improve with physical therapy.

Ask your provider to explain potential risks based on your unique situation.

What happens after this procedure?

Your recovery will begin in the hospital. Most people stay in the hospital for two to five days after surgery. During that time, your care team will:

• Check your vital signs and examine you to ensure you’re recovering without complications
• Give you medications to prevent infection and manage pain (stiffness and numbness at the surgery site are common at first, then gradually improve)
• Help you walk around (movement helps prevent blood clots and constipation)
• Start feedings through an IV and then transition you to eating with your mouth
• Care for your drain

Your healthcare providers will give you detailed instructions about how to care for yourself at home. They may advise you on:

• Wound care. You’ll need to keep your wound clean to prevent infection. You may need to apply an antibiotic ointment on your stitches until a provider removes them during a follow-up visit.
• Drain care. You’ll need to clean and empty your drain if you wear one at home. You may also need to keep track of how much fluid it collects daily.
• Showering. You’ll likely need to avoid showering until your drain is removed. Once you’re cleared to shower, cleanse the area gently instead of scrubbing.
• Eating. You’ll transition from clear liquids to solid foods. Your healthcare provider may recommend certain foods to ensure you get the nutrients you need.
• Activity. You may need to do regular exercises to help heal stiff, sore neck and shoulder muscles. You may need to do breathing exercises to keep your lungs clear.

Most people return for a follow-up visit to check on their recovery within about a week after they leave the hospital.

What is the recovery time?

Your recovery depends on many things, including how much tissue was removed, your health before surgery and the impact of cancer treatments you receive after surgery.

Still, it’s important to remember that neck dissection — no matter the type — is a major surgery. Expect to feel weak for the first few weeks at least. But recovery may take much longer. Your healthcare provider is your best resource for explaining your prognosis (outcome).

When should I call my healthcare provider?

Call your healthcare provider immediately if you notice:

• Signs of an infection (fever and redness, warmth, pain or pus at the incision site)
• New bleeding at the incision site
• Trouble swallowing
• Trouble breathing