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.