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 exploration for nodes

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.

The specific operation will be decided in conjunction with your surgeon but typically there is an area of numbness over the skin where the incisions are and occasionally some stiffness of the neck.

There may also be some stiffness of the shoulder if any of the accessory nerves are divided during the surgery.

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. Usually this will settle spontaneously.

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.

Allow 2 – 3 weeks off work post-operatively but this is an area where the specific plan for surgery, further treatment and outcomes afterwards will depend very much on individual conditions.