Contents
1. Introduction
2. What is a neck dissection?
3. Why is it done?
4. What does it involve?
5. What can I expect after the
operation?
6. Are there any complications?
7. Will my speech and swallowing be
affected?
8. Will I have a scar?
9. How long will I be in hospital?
10. What next?
11. Follow-up
1.
Introduction
This information has been designed to help you understand
neck dissections and contains answers to many frequently asked
questions.
If you have any questions that the booklet does not answer,
or would like further explanation, please ask one of the Team.
2. What is a neck
dissection?
A neck dissection is an operation, performed under a general
anaesthetic, to remove lymph nodes from the neck on one or both
sides.
3. Why is it done?
This operation is undertaken to remove suspected or confirmed
cancer in the head and neck area. Cancers arising in the head
and neck can spread through the lymphatic system to nearby lymph
nodes in the neck. If it is suspected, or known, that the cancer
has spread, then these nodes can be treated surgically or with
radiotherapy. The treatment in each case is considered
individually.
4. What does it involve?
A neck dissection is usually performed at the same time as
surgery to remove the original or primary tumour from around the
mouth, face or throat. If being done alone, the nodes will be
removed through an incision (cut) in the neck.
There are different types of neck dissection, but all have a
similar approach. 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 tissue of the neck to expose the lymph nodes.
Once the lymph nodes have been removed, the flap of skin is
replaced and skin closed together with stitches or clips.
In a radical neck dissection, all the nodes between
the jaw and collarbone are removed along with other structures
including the sternomastoid muscle, accessory nerve and jugular
vein.
In a modified, partial or selective neck dissection,
those groups of nodes and any other structure which experience
has shown to be most often involved in the spread of your type
of cancer are removed. Where possible the muscle, nerve and vein
mentioned above are conserved.
All tissue including the lymph nodes removed will be examined
for cancer cells by a specialist pathologist. This examination
may take several weeks, so you are not likely to receive the
results until you attend out-patients.
5. What can I expect after the
operation?
At the end of the operation one or two tubes or
drains are put into the neck to drain blood and fluid from the
operation area. These tubes will be removed before you go home.
For the first day or two you may have a bandage around your
neck, or the wound area may be covered with a clear plastic-like
dressing.
There will be some pain after the operation. We will
give you painkillers both when you are in hospital and to take
home with you when you are discharged. The pain will gradually
get less over the first week.
The cut in your neck is closed with stitches or skin
clips, which are removed about a week after the operation. You
may have to go to your GP to have these removed.
6. Are there any
complications?
There are some risks in having this treatment, which you
should consider before consenting for the operation. These
potential complications are rare. You should discuss these with
your doctor when you visit the hospital.
All operations carry risks, such as bleeding and infection.
These risks will be explained to you in detail at before you
sign the consent form.
Problems that may occur after neck dissection include:-
Numbness in the neck and ear. Most of this goes away
after several months, but the feeling may not return to normal.
This may be irritating but it seldom causes a major problem.
Swelling. This is most likely to occur if the
internal jugular vein is removed. It is usually temporary and
gradually goes. The medical name for this is ‘lymphoedema’, and
can be referred to Lymphoedema Clinic.
Neck stiffness. This is usually caused by the need
to remove the nerve supply to one of the large muscles in the
neck or the muscle itself. It is usually temporary and helped by
physiotherapy, which includes neck and shoulder exercises.
Nerve damage. Many important nerves run through the
neck, and the surgeon will make every effort to avoid damaging
any of them. However, sometimes it is necessary to handle or cut
and remove a nerve because it is too close to the lymph nodes
affected by the tumour. Nerves that can be affected include
those that supply the tongue (making clearing food from that
side of the mouth and swallowing difficult) and the corner of
the lip (causing it to droop). The accessory nerve supplies one
of the shoulder muscles. If it is removed, there is difficulty
lifting the arm above shoulder height and carrying a heavy
weight, such as a shopping bag, and makes getting dressed less
easy. There may also be some shoulder droop and stiffness, and
pain. If this nerve is removed, post-operative physiotherapy may
help in maintaining good shoulder function.
Chyle leak. Chyle is the fluid which runs through
the lymphatic system. Very occasionally one of the channels
carrying this fluid is damaged during the operation and chyle
leaks out. It is very difficult to see this at the time of the
operation as the fluid is clear. This may mean a return to
theatre to have the leak repaired, or staying in hospital while
it heals itself. This may involve dietary management or tube
feeding.
7. Will my speech and
swallowing be affected?
Your speech will not be affected by any of the neck
dissection operations. However, if one of the nerves that
supplies your tongue is affected during the operation, you may
need help and advice with swallowing from a speech and language
therapist. Our dietitian is also available to help you with any
nutrition problems you may have before, and after the surgery.
8. Will I have a scar?
The operation will leave you with a scar on your neck. If at
all possible, the surgeon will make the scar in a place that
blends in with the skin creases in your neck so that it is not
obvious. The scar fades over time, gradually becoming less
visible. Many people disguise it with a scarf or high-necked
blouse or sweater until it fades. If scarring is of concern to
you, a camouflage therapist can help once the wounds have fully
healed. Please ask your clinical nurse specialist for details.
If one of the large muscles of the neck is removed, the neck
will look flatter on that side.
Following surgery it is advisable to avoid sun exposure on
the scar. A high factor sun block SPF >30 is recommended.
9. How long will I be in
hospital?
You will either come into hospital the day before, or on the
morning of your operation. The time you spend in hospital
depends on the type of neck dissection, and if you are having
other surgery to remove the primary tumour at the same time. If
you are not having any other operation, you will be in for about
five days after a radical neck dissection, and three days after
one of the other neck dissections. Remember this is an estimate
– every person is different. Often factors in your medical
history, medications, smoking or alcohol intake will influence
your length of stay.
10. What next?
If you have seen a physiotherapist for help with neck and
shoulder movements and exercises when in hospital, you may need
to continue with physiotherapy as an out-patient.
Most people go home without needing ongoing care from their
district nurse. If you do need extra care, once your discharge
date is known the ward nurses will plan this with the district
nurses. You will be given any letters for your district nurse
and GP, as well as medication and dressings to take home with
you.
You will be given an out-patient appointment to see your
medical team about 10 to 14 days after your discharge. At this
time the results of the pathology report will be discussed with
you. After this you will be given monthly appointments. If
further treatment is planned, this will be discussed in detail
with you.
11. Follow-up
You will continue to have regular out-patient appointments
for a number of years.
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