Neck dissection is a surgery to remove lymph nodes that may have cancer.

Dr. Carole Fakhry of Johns Hopkins, a leader in head and neck oncologic surgery, reviews what's involved with a neck dissection.

What is neck dissection?

Cancers of the head and neck can drain into lymph nodes in the neck. A neck dissection is removal of the lymph nodes that may have cancer. The procedure is performed to determine the number of lymph nodes that have or do not have cancer.

When is neck dissection needed?

Your doctor may recommend a neck dissection if you have cancer in the head or neck areas, including cancer of the mouth, tongue, throat, nose, face, skin, saliva or thyroid gland. Lymph nodes — bean-shaped glands found throughout the body — are part of the lymph system, which also includes lymph vessels and lymph fluid. Lymph vessels carry lymph fluid through the nodes, which have immune cells that act as filters   for foreign substances such as cancer cells and infections.

Cancer cells that spread from the site of origin may travel in lymph fluid and get caught in lymph nodes, where they could grow. A neck dissection is performed to remove the lymph nodes and surrounding tissue to treat the cancer and keep it from spreading, or to determine if there is cancer in the lymph nodes.

Your doctor may also recommend a neck dissection if cancer is suspected but not diagnosed.

Types of Neck Dissection

There are two types of neck dissection surgery:

• Selective neck dissection. This is the most common neck dissection procedure. It is the removal of lymph nodes where tumors are more likely to spread. It preserves the neck’s major structures, including muscles, nerves and vessels.
• Radical neck dissection. Lymph nodes of the neck are removed, as well as the sternocleidomastoid muscle, internal jugular vein and spinal accessory nerve. This is typically reserved for when cancer affects   these important structures.

Who is a candidate for neck dissection?

A candidate for neck dissection has or is suspected to have cancer in lymph nodes in the neck area that has spread from:

• Head and neck squamous cell carcinoma 
• Skin cancer, including melanoma
• Thyroid cancer
• Salivary gland cancer
• Nasal cavity cancer

Preparing for Neck Dissection Surgery

When preparing for neck dissection surgery, follow all the instructions your care team gives you. These include:

• Do not eat or drink anything after 12 a.m. on the day of the surgery. 
• Stop certain medicines if instructed by your care team.
• Ask a family member or friend to pick you up from the hospital when you are ready for discharge and to help you at home for a few days.

How long will I be in the hospital after a neck dissection?

Each person is different. You may be able to leave the hospital the day after surgery, or when you:

• Feel well
• Can eat and drink enough
• Feel your pain is controlled
• Urinate enough
• Are comfortable taking care of your drain

Possible Neck Dissection Complications

Every neck dissection results in some degree of neck stiffness, numbness and soreness. These side effects are not considered complications, and how much and how long they are experienced varies.

In general, the complication rate for neck dissection is low. Complications depend on how extensive the surgery is, the size of the tumor and other factors. Discuss with your surgeon which complications are most likely based on your surgery. Possible complications include:

• Seroma
  • A seroma is a collection of fluid under the skin in the surgery area.   A drain is placed in the neck to lower the chance of developing this.
  • Depending on the size and location of the fluid collection, it can be managed by needle drainage, applying a pressure dressing and/or replacing a drain in the area.

• Hematoma (a pool of mostly clotted blood)
  • Bleeding is a possible complication after every surgery.
  • Blood collection in the neck can cause trouble breathing and swallowing, and it may need to be drained at the bedside in the hospital room or in the operating room.

• Shoulder weakness
  • The lymph nodes removed are close to a nerve that helps move your shoulder.
  • You may have pain or weakness after the procedure when shrugging your shoulders or raising your hands over your head. Usually, the weakness is temporary, but it can be permanent. While the nerve is recovering, it’s important to do shoulder exercises.
  • If the nerve needs to be removed (due to the cancer), the shoulder blade on the side of the surgery may look uneven.
  • Physical therapy is very helpful to improve shoulder range of motion. Even when the nerve that helps move your shoulder becomes healthy, exercises are recommended to prevent a frozen shoulder. A physical therapist or occupational therapist will show you how to do these exercises.

• Lower lip weakness
  
  • A small branch of the facial nerve in the neck helps you move the lower lip. Every effort is made during surgery to protect this nerve.
  • Weakness of this nerve may lead to drooping of the corner of your mouth. You may notice an uneven smile. Drooling occurs in rare cases.
  • This weakness is usually temporary, but in rare cases, it is   permanent. If the nerve was not purposely cut or removed because of the tumor, this weakness should improve in three to six months, but it can take up to a year.
  • If the lip does not become better, a facial plastic surgeon may be able to restore function.

• Tongue weakness
  
  • A nerve in the neck helps you move your tongue. Weakness of this nerve may lead to weakness moving the tongue on the same side as the neck surgery.
  • The nerve weakness, which is usually temporary, may cause some difficulty eating or saying some words clearly. If the nerve was not removed or injured because of the tumor, this weakness usually becomes better within a few months but it can take up to a year.

• Chyle leak
  
  • Chyle is a milky fluid made in the gut when fat is digested. It is carried in lymphatic vessels that empty into small channels in the neck.
  • A chyle leak may happen when these channels are cut during surgery. It’s more common on the left side than the right side of the neck.
  • Chyle fluid may cause problems with wound healing and nutrition. They   can usually be treated with changes in diet.
  • Let your doctor know if you see milky fluid in the drain. You may be asked to follow a low-fat or fat-free diet.
  • If diet changes do not correct the problems caused by the leak  , you may be given medication, a pressure dressing may be put on the neck or  , in rare cases, a feeding tube will be placed. 
  • For very large leaks that do not respond to diet changes or medications, surgery may be needed.

How will I feel after a neck dissection?

People recover at different rates. You may feel tired for the first couple of weeks after surgery. Be kind to yourself — it’s important to give yourself time to rest and recover. Much of the discomfort you will initially experience is temporary and will improve with time. Some throat discomfort is expected from having a breathing tube during surgery. Overall, the pain can be managed by exercises and by medications that your treatment team provides.

Wound Care

• If skin glue was used as part of your surgery:
  
  • Keep the area clean and dry.
  • Do not pick off the glue.
  • The glue will fall off after a few weeks.

• If you have stitches:
  
  • Apply antibiotic (bacitracin) ointment and petroleum jelly along your stitches twice each day until they are removed.

• If you have a drain:
  
  • You may have a drain that was placed in the neck to remove fluid after surgery. While in the hospital, nurses will take care of the drain. If you leave the hospital with the drain, you will need to strip the drain, empty it and measure the fluid amount three times each day. Your nurses will teach you how to do this.
  • You will need to call a nurse to have your drain removed once the fluid amount within a 24-hour span is low enough (typically less than 25 cubic centimeters).

Eating After Neck Dissection Surgery

Eating ability is different for every patient. You may initially find it difficult to swallow because your neck feels tight and swollen. This is common. You will start with drinking clear liquids and can advance to solid foods as you tolerate them. For some patients, it is helpful to tuck the chin down to the chest when swallowing, or to eat thick foods such as applesauce. It’s important to recognize the signs and symptoms of saliva, liquids or solid foods spilling into your windpipe. This can lead to serious medical problems such as pneumonia.

When are final pathology results after neck dissection ready?

A pathology report is usually ready one to two weeks after surgery. Your treatment team will discuss the report with you, and the results guide the next steps in treatment or surveillance.

It’s important to follow up regularly with your doctor after the cancer has been treated. Follow-up is generally more frequent in the beginning (every three months during the first year), but the time between follow-up visits will become longer as more time passes (every four months in the second year, for example). Your surgeon will advise how often you need to be seen, and some visits will be shared with other specialists.

You may need imaging during your follow-up visits. Some patients who remain without symptoms do not need imaging. Depending on the cancer and treatment regimen, you may need lab tests to monitor hormone levels.

Follow up sooner than your scheduled times if you notice new symptoms that last longer than a few weeks, such as hoarseness, swallowing issues, mouth or throat pain, bleeding or unexpected weight loss.