Neck dissection | North Bristol NHS Trust

What is a Neck Dissection?

There are different types of Neck Dissections. Your Consultant will discuss with you the details of the operation you are having.

Radical 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 collarbone. This is usually planned if there is evidence that lymph nodes in the neck are affected and particularly if they are bulky. Because the nodes are small and stuck to other structures in the neck, they are usually removed with some surrounding tissues as well, to make sure all the diseased tissue is removed. The only structures which are removed are those which you can safely do without.

Selective Neck Dissection

A selective Neck Dissection is performed when the amount of disease in the neck is small, or when there is a suspicion that there may be microscopic amounts of cancer cells in your neck. In this case, only the groups of lymph nodes that experience has shown to be most often affected in your type of cancer are removed.

Parotidectomy

A parotidectomy can be performed at the same time as your neck dissection; this is called a Parotid and Neck Dissection. Parotidectomy is the surgical removal of the parotid gland, the major and largest of the salivary glands. The operation is usually performed if your consultant is concerned there are cancer cells within the parotid gland. Your parotid glands are found in your cheeks, over your jaw and in front of your ears. The operation involves making a cut in front of the ear. This cut is extended either downwards into the neck or behind the ear.

The parotid glands are one of the glands that release saliva (spit) into your mouth and saliva is needed to help with chewing and swallowing.

After your operation the tissues will be sent to the laboratory to search for cancer cells and to see how extensive the spread has been.

Why do I need a Neck Dissection?

A Neck Dissection is usually performed to remove a malignant tumour. The aim of a Neck Dissection is to remove lymph nodes from one or both sides of the neck. This is undertaken when the cancer cells have travelled from the original skin cancer site and settled in the lymph nodes in the neck. A neck dissection involves removal of the lymph glands and tissues affected by the tumour. Your Consultant aims to preserve all vital structures where possible including blood vessels and nerves.

What are Lymph Nodes?

Lymph nodes are present throughout your body. You may have felt swollen lymph nodes in your neck when you have had an infection such as a simple cold. As well as trapping germs, the lymph nodes can also trap cancer cells.

Have I got cancer in my lymph nodes?

When a lump is detected, the first step is to have an ultrasound guided biopsy. The sample taken is sent to the laboratory to be looked at under a microscope. Your Consultant will also request scans (CT, MRI) prior to your surgery.

When will my Neck Dissection be carried out?

A Neck Dissection is carried out once all the test results are available. You will be required to attend a pre-assessment appointment where the nurse will ensure you are fit for a general anaesthetic. You will be admitted to hospital early on the morning of your surgery and can expect to remain as an inpatient for around 3 days.

What happens on the day of surgery?

On the day of your surgery, you will be admitted to the admission lounge. From there you will be taken up to the Medirooms where you will meet your Consultant and your anaesthetist.
You will be asked to sign a consent form for the treatment and asked to change into a hospital gown.

You will then be taken into the theatre suite where you will be given a general anaesthetic which means you will be asleep throughout the procedure.

Under general anaesthetic a large incision is made which usually starts just underneath the chin and extends downwards towards the collarbone, then upwards to end behind the ear. Once the lymph nodes have been removed, the flap of skin is repositioned with stitches or clips. This operation usually takes between 3-5 hours, but you will be away from the ward for most of the day.

The lymph nodes that are removed are sent for histopathology analysis to determine the tumour stage.

What can I expect after the operation?

At the end of the operation two or three small plastic tubes are placed through the skin to drain any fluid that may collect inside the wound. The other ends are connected to bags that usually stay in place for several days before being removed. Some discomfort is to be expected and is usually worse for the first few days, although it may take a couple of weeks to disappear completely. If required, you will be given regular painkillers. The following day you will be encouraged to gently walk around the ward. You may also need to see the physiotherapist for an exercise programme.

You will usually be discharged home with the drain once you have been taught to look after it and are happy to do so and you will be able to contact your Skin Cancer Nurse if you require any additional advice.

Before you are discharged from hospital you will be given an appointment to come back to the plastic surgery outpatient clinic, where your wounds will be reviewed and the drains will be removed when appropriate. Any stitches or clips will be removed around 7-10 days following surgery.

What are the risks and side-effects?

There are potential problems with any operation. With this type of surgery, complications are rare, but you may experience some of the following:

Numb skin – the skin of the neck will be numb after the surgery. This will improve to some extent but may not fully return to normal.
Stiff neck – You may find that your neck is stiff after your operation. You may be referred to a physiotherapist to help with your movement.
Haematoma – Sometimes one of the drains becomes blocked, causing a blood clot to collect beneath your skin (a haematoma). If this happens, further surgery may be required to remove the clot and replace the drain.
Chyle leak (pronounced ‘kile’) – Chyle is the name given to digested fats that are transported from the gut in the lymphatic system. Occasionally one of the lymph channels, called the thoracic duct, is damaged during a neck dissection. This can be hard to spot during the operation. If this occurs, chyle can collect under your skin or may be seen in your neck drain. If you have a chyle leak you will usually be placed on a fat-free or modified fat diet for a period of time (usually 2-3 weeks) until the leak has healed, or you may be taken back to theatre to repair the leak. Very occasionally, it is necessary to feed you intravenously.
Damage to the accessory nerve – This is the nerve to one of the muscles of the shoulder. Your Consultant will try to preserve this nerve but sometimes it needs to be removed because it is too close or involved with the tumour to leave. If the nerve is preserved, it can be bruised during surgery. Your Consultant may refer you to the physiotherapy department who will give you shoulder exercises to help with movement.
Damage to the hypoglossal nerve (nerve that moves the tongue) – Very rarely removed unless involved with the tumour, if it is removed, you may not notice any obvious changes. If there is any significant functional changes, speech and language therapy can be provided.
Marginal mandibular nerve damage – This nerve is also at risk during the operation, but your Consultant will try to preserve it. If it is damaged, you will find that the corner of your mouth will be a little weaker. This is more obvious when smiling. Lip closure may be weaker on that side, which may occasionally result in a little dribbling when eating and drinking. The speech and language therapist can suggest exercises and strategies that may help improve this function if needed.

How long will I need off work?

This is different for every individual, but taking at least two to four weeks off from your job or from looking after your home and family after leaving hospital would be reasonable.

Will I be seen in the outpatient clinic following my Neck Dissection?

You will be given an Outpatient appointment before you leave hospital. At your first appointment, your Consultant will review the wounds and replace the dressings.

When the results are ready, (this can take between 2-4 weeks following surgery), you will receive a further Outpatient appointment to discuss them and any further arrangements can be made at this time.

Will I need to have further treatment after my Neck Dissection?

Any further treatment that you may require will depend on what is found when the lymph nodes are examined under a microscope.

Your Consultant will not know if you will need additional treatment until the results are received.

If you require additional treatment, this usually involves specialised X-ray treatment in the form of radiotherapy at an Oncology centre. You may not need any further treatment at all and you will have regular follow-up appointments in Outpatient department.

References and further Information

NGS Macmillan Wellbeing Centre,

Southmead Hospital, Bristol BS10 5NB
Southmead Hospital has a drop-in centre offering a variety of activities/services. For more information telephone 0117 4147051 or ask your Skin Cancer CNS.

Skin Cancer Research Fund (SCaRF)

Based at Southmead Hospital
Telephone: 0117 414 8755
www.skin-cancer-research-fund.org.uk [Last accessed January 2011]

Macmillan Cancer Support

Europe’s leading cancer information charity with over 4,500 pages of up-to-date cancer information, practical advice and support for cancer patients, their families and carers
Telephone: 0808 800 1234
http://www.macmillan.org.uk [Last accessed January 2011]

Cancer Help

Cancer Help UK is a free information service about cancer and cancer care for people with cancer and their families. Cancer help believes that information about cancer should be freely available to all and written in a way that people can easily understand.
www.cancerhelp.org.uk

How to contact us:

Skin Cancer Clinical Nurse Specialists:
Lynda Knowles
Joanne Watson
Claire Lanfear
Samantha Wells

Tel: 0117 414 7415

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.