NECK DISSECTION
WHAT IS NECK DISSECTION?
Neck dissection is an operation to remove diseased lymph glands or nodes in the neck.
Depending upon the area affected, there are three differing levels of surgery. In general terms, a radical neck dissection involves complete removal of nodes, the main neck muscle called the sternocleidomastoid, the internal jugular vein and the spinal accessory nerve.
A modified radical neck dissection is similar to the radical procedure but spares the spinal accessory nerve.
The most conservative approach is that of the selective neck dissection, which removes only the affected node(s), thus preserving the sternocleidomastoid muscle, internal jugular vein and the spinal accessory nerve.
Lymph nodes are glands that are present throughout your body. You may have felt swollen lymph nodes in your neck when you have had an infection such as a simple cold. Their job is to filter the liquid which naturally leaks out of blood vessels. This liquid (the lymph) travels to the nodes which contain lots of white blood cells designed to trap and fight germs which can cause infection. As well as trapping germs, the lymph nodes can also trap cancer cells.
Treatment
The operation is carried out under general anaesthetic and can take two to three hours.
A large incision is made to gain access to the lymph nodes in the neck. The cut usually starts just underneath the chin and extends downwards towards the collar bone before arcing upwards to end behind the ear. This flap of skin is lifted off the tissues of the neck to expose the lymph nodes. Once the lymph nodes have been removed the flap of skin is replaced with stitches or clips.
After the operation
At the end of the operation a number of tubes are placed through the skin into the wound to drain any blood which may collect. These usually stay in place for a couple of days before being removed. Some discomfort is to be expected and is usually worse for the first few days although it may take a couple of weeks to completely disappear. It is necessary to make sure that the incisions heal without any infection and so you will be given antibiotics through a vein in your arm whilst you are in hospital. You will also be given regular painkillers.
The skin stitches or clips will be removed around a week following surgery. The skin of your neck will feel numb for several months after surgery as a result of bruising to the nerves.
What are the risks
There are potential complications with any operation. Fortunately with this type of surgery complications are rare and may not happen to you. However it is important that you are aware of them and have the opportunity to discuss them with your surgeon. Most of the problems associated with neck dissection are the result of damage to one of two nerves:
Accessory nerve – this is a nerve which runs from the top to the bottom of the neck and helps you to move your shoulder. The nerve has lots of lymph glands lying very close to it and so it is often bruised during a neck dissection. If the nerve is bruised it can stop working for several months. If this happens you may experience pain and some difficulty in moving your shoulders which makes getting dressed less easy. Rarely the lymph nodes cannot be completely removed without cutting this nerve. Should this be the case then these shoulder problems will be permanent.
The branch of the facial nerve which makes your lower lip move can be bruised when the lymph nodes close to it are removed. If this happens then the lower lip doesn’t move properly and you may end up with a weakness which results in a crooked smile. The majority of these get better on their own but can take several months to improve fully.