What is a neck dissection?

A neck dissection is a surgical procedure that involves removing the lymph nodes in the neck if cancer has spread. As cancer cells multiply and spread, they may move into the lymph nodes where they can continue to multiply. The number of lymph nodes and amount of surrounding tissue that needs to be removed will depend on what stage cancer you have, as well as the type of cancer you have.

Who is a candidate for a neck dissection

If your thyroid cancer has spread to the lymph nodes or your doctor suspects that it is spreading, you may need a neck dissection to remove the lymph nodes in the neck.

The most common cancers that affect the neck and may require a neck dissection are head and neck squamous cell carcinomas, melanoma and thyroid cancer.

Risks associated with a neck dissection

A neck dissection is a complex procedure that may result in complications during and after surgery. Risks may include:

  • Severe bleeding – Although rare, patients can experience severe bleeding that requires either surgery to remove the pooling blood or a blood transfusion.
  • Infection – While also rare, you can develop an infection at the incision site after surgery.
  • Fluid accumulation in the neck – If you have a left side neck dissection, you are at greater risk of develop a Chyle leak, where fluid accumulates in the neck.
  • Issues with wound healing – Some patients require surgery if they have issues with their wounds healing effectively.
  • Nerve damage – Due to the complexity of the anatomy in the neck, nerve damage can occur in the marginal nerve (nerve that controls lower lip movement), spinal accessory nerve (nerve that aids in shoulder mobility), hypoglossal nerve (nerve that controls tongue movement), lingual nerve (nerve that controls sensation on the side of the tongue) or vagus nerve (controls movement of vocal cord).
  • Neck stiffness or pain
  • Lymphedema
  • Changes in speech or swallowing

What to expect during a neck dissection

Neck dissections are performed in a hospital operating room under general anesthesia. What you can expect will depend on which type of neck dissection you are having. During a modified radical neck dissection (the most common type), your incision will run along the crease of the neck and run vertically to the side of the neck. This surgical incision location is ideal to minimize scarring, while also enabling the surgeon to safely remove any cancerous lymph nodes.

There are 2 main categories of neck dissection procedures — radical neck dissection and modified neck dissection.

  • Radical neck dissection
    A radical neck dissection involves removing the lateral neck lymph nodes as well as surrounding tissue in order to remove cancer in the neck. This technique is less frequently used than a modified radical neck dissection but may be used in patients with advanced cancer where removing as much tissue as possible is important.

    Patients who undergo a radical neck dissection may have cosmetic deformities as a result of the amount of tissue that is removed. You also could have severe nerve damage that will lead to a long-term disability.

  • Modified radical neck dissection 
    A modified radical neck dissection is a term that is used to describe various neck dissections. These procedures aim to preserve the structures such as the spinal accessory nerve, internal jugular vein or sternocleidomastoid muscle. Modified radical neck dissections also try to preserve some of the lymph nodes by removing the lymph nodes that are likely to have cancer. 

    Most patients prefer a modified radical neck dissection because they will not have obvious cosmetic changes. Patients may still have to do physical therapy after the procedure to enhance shoulder and neck range of motion.

Recovery after a neck dissection

After the neck dissection is complete, you will be moved to the Post Anesthesia Recovery Unit (PACU). You may need to be given oxygen through a tube while in the PACU. Your care team will monitor your vitals and move you to a regular hospital room when you are stable. Some patients may need an overnight stay in the PACU.

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