Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon
Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

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Neck Dissection

Most cancers which start in the head and neck region have the ability to spread to other parts of the body; these are called metastases (‘mets’) or ‘secondaries’. Cancers can spread in a number of different ways, most often by the lymph system to lymph nodes and sometimes by the blood to other distant organs like the liver.

In the head and neck region, localised lymphatic spread 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, the deeper neck structures and upper aerodigestive tract. 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.

A fine needle aspirate, sometimes under ultrasound control, can be used to diagnose the nature of the cells present in a nodal swelling in the neck.  If these are malignant, they have often originated from a head and neck primary source, and is important that the primary areas are fully examined, sometimes under general anaesthesia with biopsy, to fully assess the stage of the disease so that treatment can be planned accordingly.

When a neck swelling needs to be removed this can be in the form of either a radical dissection, aiming to remove all the lymph glands in the neck, or a more limited functional or partial neck dissection to remove the most likely involved nodal areas but possibly attempting to preserve some of the nodes and particularly other structures such as the sterno-mastoid muscle, accessory nerve (which assists shoulder movement) and the internal jugular vein.

There are two basic types of neck dissection:

A radical neck dissection is a surgical operation which 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 small and adherent to structures in the neck, so usually other tissues are removed as well to ensure that all parts of the cancer nodes are cleared. The intention is to only remove structures which do not leave serious long-lasting effects.

A partial neck dissection is performed when there are strong suspicions that there may be only microscopic amounts of cancer cells in nodes in the neck. In this case usually only those groups of nodes most likely to be affected in the particular type of cancer involved are removed.

In both types of operation all the tissues removed are sent away to a laboratory to be examined microscopically, often using stains, to establish a “histological” diagnosis of the cancer type and establish the extent of spread of the disease.

Most patients will be admitted one or two days before their operation. In many cases the neck dissection is only part of the surgery and the patient may also be having another procedure aimed at removing the primary or original tumour. The operation is performed under general anaesthetic. There will usually be two long cuts made in the neck. At the end of the operation there will be 1 or 2 drain tubes coming out through the skin and stitches or skin clips to the skin. Most patients do not have much pain after the operation. There may be removal of one of the large muscles from the neck causing one side of the neck to look a little flatter on the side of the operation.  The neck may  be a little stiff after the operation; this may be due to muscle removal or the need to sacrifice a nerve which contributes to the initiation of shoulder movement

Possible specific complications

Numb skin:

The skin of the neck around the area of the incision, at least, will be numb after the surgery. This will improve over time to some extent, but may not fully return to normal.

Stiff neck:

Some patients find that their neck is stiffer after the operation. There may also be some stiffness of the shoulder if any of the accessory nerves are divided during the surgery.

Blood Clot:

Sometimes the drain tubes inserted during surgery can become blocked, causing blood to collect under the skin and form a clot (haematoma). 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 tissue fluid, which runs in lymph channels. There may occasionally be a leak of lymph fluid from the area of the thoracic duct, which is an area very close to the operative field, and which returns tissue fluid from the rest of the body to re-enter the circulation.

Occasionally the thoracic duct leaks after the operation. If this occurs, lymph fluid, chyle, can collect under the skin, in which case it is necessary to stay in hospital longer and sometimes this requires further surgery, although this can settle spontaneously.

Injury to the Accessory nerve:

This is the nerve to one of the muscles of the shoulder. The intention is to preserve this nerve but sometimes it needs to be removed, because it is too close to the tumour to leave behind. In this case the shoulder may become a little stiff and that it can be difficult to elevate the arm above the shoulder.  Lifting heavy weights, such as shopping bags, may also be difficult.

Injury to the Hypoglossal nerve/Lingual nerve:

Two of the nerves which may be bruised in the procedure are the hypoglossal nerve, which supplies movement of the tongue, and also the marginal mandibular nerve which can produce a weakness of the angle of the mouth.  Very rarely, the hypoglossal nerve (which makes the tongue move) also has to be removed due to involvement with the tumour. In this case it becomes more difficult to clear food from that side of the mouth and it can interfere with swallowing.

Injury to the Marginal Mandibular nerve:

This nerve is also at risk during the operation, but the aim is to preserve it. If it is damaged the corner of the mouth becomes a little weak; this is most obvious when smiling.

Additional treatment

This will depend on previous treatment, the location and type of the tumour.  Sometimes, radiotherapy may be utilised in addition to surgery, either before or afterwards.

Time off work

This will depend on the type of treatment and should be discussed with the responsible ENT surgeon; typically at least three weeks off work will be necessary and return to normal function may take longer and is not always complete.