Neck-dissection

What is a neck dissection?

A neck dissection is an operation aimed at removing all lymphatic tissue in the neck. Together with the lymph nodes we also remove fat and sometimes other structures such as blood vessels, nerves and muscle.

There are different types of neck dissection determined by what structures should be preserved and how extensive surgery should be.

How do cancers spread?

Cancer originating in the head and neck region tends to spread (metastasize) to other parts of the body. The commonest way of spread is through the lymphatic system and less commonly through the blood circulation. The lymph nodes in the neck are part of the immune system that serve for the fight infections. Each group of nodes drains a particular area of the body. In the neck the lymph nodes drain the upper aerodigestive tract and the skin of the head and neck. When cancer cells reach the nodes they make them grow.

What does the operation involve?

The operation is done under a general anaesthetic usually by a team of surgeons. The neck dissection is usually only part of the operation as there is a need for removing the primary tumour as well. On top of that there might be a need for reconstruction of the defect left with tissue from regional or distant parts of the body. A long incision is made in the neck extending only to one or both sides and drain tubes are left in place at the end of the operation to prevent a blood clot occurring under the skin. The skin is then closed with sutures or clips.

What are the possible complications?

Skin numbness:

The skin around the wound will be numb for some time after the operation but this usually improves gradually.

Haematoma:

Clotted blood under the skin around the wound can form in a small number of cases. Sometimes this might necessitate return to theatre for surgical drainage.

Chyle leak:

Chyle is fluid that runs in lymphatic channels. Occasionally one of these channels found in the neck called the thoracic duct leaks after the operation. If this occurs chyle can collect under the skin and if it does not settle on its own it might necessitate going back to theatre to seal the leak.

Injury to the accessory nerve:

This nerve runs across the neck and supplies a muscle in the shoulder. If this gets damaged the shoulder should feel stiff and the arm will be difficult to raise above the shoulder.

Injury to the hypoglossal nerve:

This is the nerve that makes the tongue move. If this gets damaged it should feel difficult clearing food on the side of the mouth it was damaged.

Injury to the marginal mandibular nerve:

If this nerve gets damaged it should cause weakness of the corner of the mouth most obvious when smiling.

Will I need any further treatment?

This will depend on the type of tumour and where it is. It will also depend on what treatment you had already if any? It involves radiotherapy with or without chemotherapy.

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