This information will help you prepare for your neck dissection surgery.
Head and neck cancers can spread to the lymph nodes. Lymph nodes are small oval or round bodies along the lymphatic system. If your doctor thinks there is a high risk that the cancer may spread to the lymph nodes in the neck, or if it has already spread to those nodes, your treatment may include a neck dissection. This is a surgery in which the lymph nodes in the neck region are removed.
There are various levels of lymph nodes in the neck. The most likely pathway for the spread of cancer to these lymph nodes depends on the site of the cancer. For example, in cancers of the mouth, the pathway is to lymph nodes at levels I, II, and III (see Figure 1).
In cancers of the throat, the pathway of spread is to levels II, III, and IV. The lymph nodes in level V are more commonly affected by thyroid cancer and extensive tumors of the oral cavity, the back of the nose, or the throat.
In addition to the lymph nodes, other structures in the neck may need to be removed. These structures include:
- The muscle on the side of your neck that helps you turn your head. When this muscle is removed, there will be an indentation on that side of your neck. You will still be able to move your neck without difficulty.
- The nerve that allows you to raise your arm higher than your shoulder. The surgeon will try to save this nerve. If it must be removed, you will have trouble raising your arm higher than a 90-degree angle on the side of your surgery.
- A major vein that collects blood from the brain and surface area of the face and neck. Removal of this vein on one side of the neck will not cause problems for you. Other veins in the neck will collect and circulate the blood on that side of the neck and face.
- A salivary gland in the upper part of the neck. Removal of this gland will not cause any damage to your salivary function.
Types of Neck Dissections
There are several types of neck dissections. The type you will have depends on where the cancer is, whether it has spread to the lymph nodes, and whether it has spread to other structures in your neck. Sometimes, your surgeon can tell which lymph nodes are affected by examining you. If this is not possible, you may need to have a CT scan or ultrasound of the neck to provide the surgeon with images of the affected area.
Your Hospital Stay
Your doctor or nurse will be able to tell you roughly how long you will be in the hospital. You will be given instructions on how to care for your wound. Your doctor will see you for your first follow-up visit about 1 week after you leave the hospital.
Caring for Your Incision
Your surgeon will close your incision with staples or sutures. The type of incision depends on which level of lymph nodes needed to be removed. You can discuss which type of incision will be required with your surgeon.
A drain called a ReliaVac® will be placed in your neck during your surgery (see Figure 2). It helps prevent fluid from collecting under your skin. The drain does not hurt. The drain is emptied regularly. When the drainage is less than 15 mL or ½ ounce, the drain is removed. You will be discharged on that day.
If you stay in the hospital for longer than 1 week:
- Some or all of the staples or stitches will be removed before you leave.
If you stay in the hospital for less than 1 week:
- The staples or stitches will be removed during your first follow-up visit with your doctor after your surgery.
- If you have received radiation therapy to your neck before your surgery, your staples or stitches will remain in place for 2 to 3 weeks.
It is very important that you keep your incision clean to remove crust. Crust can collect bacteria and lead to infection. Your doctor or nurse will teach you how to care for it before you are discharged. Once you are home, you must care for your incision daily as described below.
Gather the following supplies:
- Cotton swabs, e.g., Q-Tips®
- Normal saline
- Bacitracin ointment
- Take a swab and dip it into normal saline once. Gently go along the incision line around the staples or sutures. Repeat this step with a fresh swab as many times as it takes to clean the incision. Remember that you can only dip the swab once. You must use a clean swab each time you dip it into the saline. The swabbing will help loosen any crust that may have developed along the wound.
- Apply a small amount of bacitracin to the incision with a clean swab.
Your lymph nodes will be examined for cancer after they are removed. These results are usually ready in 5 to 7 business days. You may need radiation therapy, chemotherapy, or both. If you have thyroid cancer that has spread to any of the lymph nodes, you may need to have treatment with radioactive iodine. Your doctor will discuss the report with you during your first office visit after surgery. Call your doctor or nurse to schedule your follow-up appointment.
You will be given a booklet that shows you how to do exercises when your staples or stitches are removed. The exercises will help you move and use your affected arm and shoulder and achieve the most function. It is very important that you do the exercises every day.
In addition to the neck exercises, you may need physical therapy to achieve the maximum range of motion and use of your shoulder, arm, and neck.
Call Your Doctor or Nurse Immediately if You Have:
- A temperature of 100.4° F (38° C) or higher
- Increased discomfort, redness, or both around your incision
- Skin around the stitches that is hot to the touch
- Drainage or accumulation of fluid from the incision