Surgical Procedures: Neck Dissection

What is a neck dissection?

A neck dissection is the removal of lymph nodes and nearby tissue from the neck to treat cancer. It may be known already that there are cancer cells in the lymph nodes, or some may need to be tested for cancer cells. The number of lymph nodes and the amount of tissue removed depends on the stage and type of your cancer. You may need more treatment like radiation or chemotherapy after a neck dissection.

There are two types of neck dissection:

• Radical Neck Dissection: This surgery removes the lateral neck lymph nodes (all of the lymph nodes on one side of the neck) and tissues including the tissue from the collarbone (lower part) to the jawbone. It may also remove the submandibular gland (which makes saliva), the sternocleidomastoid muscle, the jugular vein, and the spinal accessory nerve. The goal is to remove all of the cancer. There will be changes in how you look and how your body works. One side of your neck may seem flatter than the other, your shoulder may droop, and you may have trouble raising your arm. Pain can also be a side effect. Physical therapy can help manage some of these problems, but it is likely that you will have some long-term side effects from the surgery.
• Modified Neck Dissection: This type of surgery removes less tissue than a radical neck dissection. Also, only certain groups of lymph nodes are removed. This lessens physical changes to how you look. You should still be seen by a physical therapist to help you manage any changes.

What are the risks of neck dissection?

As with any surgery, there are risks and possible side effects. They can be specific to your situation and the type of neck dissection you are having. These can be:

• Bleeding.
• Infection.
• Chyle (bodily fluid that contains lymph and fatty cells) leak (the fluid gathers in the neck).
• Wound healing issues.
• Nerve damage. There are many nerves that run through the neck and they could be damaged during surgery. They can also be affected by scar tissue after healing. They include:
  • Marginal Nerve – controls moving the lower lip.
  • Spinal Accessory Nerve – helps move the shoulder and raise the arm above the head.
  • Hypoglossal Nerve – controls moving the tongue.
  • Lingual Nerve – controls sensation on the side of the tongue.
  • Vagus Nerve – controls movement of one vocal cord.

There are also some long-term problems that can be caused by surgery. For most people, they will go away in about 6-12 months. These may be:

• Numbness of the skin along the incision, and over the cheek, ear, and neck.
• Stiffness of the neck.
• Pain.
• Lymphedema.
• Weakness in the shoulder.
• Changes in how you talk and swallow.

Before surgery, your provider will talk to you about any other risks, based on your health and the surgery you are having. They will also talk to you about ways to manage side effects after surgery.

What is recovery like?

Recovery from a neck dissection depends on the procedure you have had. You will be in the hospital for several days. You may need drains in the neck to let fluid drain out and a urinary catheter (to collect your urine).

You will be told how to care for your incisions (surgical cuts) and drains and will be given any other instructions before leaving the hospital. You may need to change your diet and a dietitian will be able to recommend foods for you. Make sure to go to your follow-up appointments as scheduled.

Your care team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention, and/or other conditions.

Your provider will talk to you about changes in your activity level, which depends on the surgery you had.

• Do not use hot/cold compresses, hot water bottles, or heating pads on your incision. If nerves were damaged during surgery, you may not be able to feel extreme temperatures.
• Do not use scented lotions, perfumes, or colognes until you are told that you can.
• Shower and clean your incision as instructed. If you have drains, empty them as directed.
• Do not lift anything heavy, strain to have a bowel movement, drive, or fly in an airplane until your provider tells you it is ok to.

What will I need at home?

• Thermometer to check for fever, which can be a sign of infection. Your care team will tell you at what temperature you should call them.
• Wound and drain care supplies as needed.
• Pillows to support your head, neck, and shoulders.

When should I call my provider?

Your healthcare team will give you guidelines for when you should call the office. Often, you should call your provider’s office if you have:

• A fever. Your providers will tell you at what temperature you should contact them.
• Pain, drainage, swelling, redness, and/or warmth at the incision site.
• Fluid building up under the incision.
• Any other new or worsening symptoms.
• Shortness of breath or chest pain.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.