"NECK DISSECTION"

Most cancers that start in the head and neck region have the ability to spread to other parts of the body. This is most often by the lymph system to lymph nodes and sometimes by the blood to other body organs like your lung or liver.

Foe head and neck cancer lymphatic spread to the lymph nodes in your neck is quite common, but spread by blood to distant parts of the body is uncommon. Lymph nodes (also called lymph glands) catch bacteria, viruses or cancer cells in the body. Each node drains a particular area of the body. The nodes in the neck drain the skin of the head and neck and all the swallowing and breathing tubes. Once one cancer cell has been ‘caught’ by a lymph node it can grow and multiply there, and in time can spread to the next node down the chain and so on. The operation in your neck is done to remove the lymph nodes.

Neck dissection is the operation to remove lymph nodes from the neck. There are two basic types of neck dissection:

  • A radical neck dissection is more extensive operation that aims to remove all the lymph nodes in the neck between the jaw and the collarbones. This operation may be carried out if there is evidence that there are one or more nodes affected with cancer in the neck. The nodes are often stuck to structures in the neck, so we usually remove other tissues as well to ensure that we remove all parts of the cancer nodes. We only remove structures, which you can safely do without, and those that do not leave serious long-lasting effects.
  • A partial neck dissection is performed when there is suspicion that there may be only microscopic amounts of cancer cells in nodes in the neck.

In this case we tend to only remove those groups of nodes, which are most likely to be affected in your type of cancer. In both sorts of operation we send all the tissues away to the laboratory to search for cancer cells and to see how extensive the spread has been.

In most cases the neck dissection is only part of the surgery and you may also have some other procedure aimed at removing the primary or original cancer. Neck dissection takes about 3-4 hours and is done under general anesthetic, which means that you will be asleep throughout. There will usually be one or two long cuts made in the neck. Some of the common ones are shown below. At the end of the operation you will have 1 or 2 tubes coming out through the skin that prevent fluid and blood collecting there and these will be removed after 2-3 days. You are likely to go home after that if you did not have any additional operation.

The skin of the neck will be numb after the surgery. This will improve over time to some extent, but you should not expect it to return to normal.

It is common to find that the neck is stiffer after a radical neck dissection but this is limited after a partial neck operation.

Most patients do not have much pain after the operation. You may find that moving your neck worsens your pain. We will give you sufficient painkillers to keep you comfortable after the operation.

In most cases you will need at least two weeks off from work. This may be longer if you have had additional operations or have a physically demanding occupation.

The skin cut will leave a scar after operation that will get faint with time. Because we remove nodes and some muscle, you may find that your neck looks a little flatter on the side of the operation.

Serious or significant complications are rare after neck dissection but can include -

  • Blood Clot: Sometimes the drain tubes, which were put in during surgery, can become blocked, causing blood to collect under the skin and form a clot (hematoma). If this occurs it is usually necessary to return to the operating room to remove the clot and replace the drains.

  • Chyle leak: Chyle is the tissue fluid, which runs in lymph channels. Occasionally one of these channels called the thoracic duct found on the left side of the neck, leaks after the operation. If this occurs, lymph fluid or chyle can collect under the skin, in which case we need to keep you in hospital longer and sometimes need to take you back to the theatre to seal the leak.

  • Injury to the nerve to shoulder muscle: This is the nerve to one of the muscles of the shoulder. I usually preserve this nerve but sometimes it needs to be removed, because it is too close to the tumour to leave behind. In this case you will find that your shoulder is a little stiff and that it can be difficult to lift your arm above the shoulder. Lifting heavy weights, like shopping bags, may also be difficult.

  • Injury to the nerve that moves your tongue: Very rarely, the nerve that makes your tongue move also has to be removed due to involvement with the tumour. In this case you will find it difficult to clear food from that side of the mouth and it can interfere with your swallowing.

  • Injury to the nerve that moves the lower lip: This nerve is also at risk during the operation, but we also try hard to preserve it. If it is damaged you will find that the corner of your mouth will be a little weak. This is most obvious when smiling.

This will depend on what treatment you have had already, where your tumour is and what type of tumour it is. Sometimes we add radiotherapy to surgery if we think this may give a better chance of a cure.

CLINIC INFORMATION

Northampton General Hospital
NHS Hospital
Northampton NN1 5BD
Tel - 01604 634700
BMI Three Shires Hospital
Private Hospital
Northampton NN1 5DR
Tel - 01604 620311

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