This guide will help you prepare for your neck dissection surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery. Read through this guide at least once before your surgery and then use it as a reference in the days leading up to your surgery. Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.Back to top
About Your Surgery
Head and neck cancer can spread to your lymph nodes. Lymph nodes are small oval or round glands along your lymphatic system. In your neck ,your lymph nodes are organized into levels (see Figure 1).
If your doctor thinks that there’s a high risk that the cancer may have spread to the lymph nodes in your neck, or if it has already spread to those nodes, your treatment may include having a neck dissection. This is a surgery to remove the lymph nodes in the neck area.
There are several types of neck dissections. The type you will have depends on where the cancer is, whether it has spread to your 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 isn’t possible, you may need to have a computed tomography (CT) scan or ultrasound of your neck so that your surgeon can see the area better.
In addition to the lymph nodes, other structures in your neck may need to be removed, including:
- The muscle on the side of the neck that helps you turn your head. When this muscle is removed, there will be an indent 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. Your surgeon will try to save this nerve. If it must be removed, you will have trouble raising your arm above a 90-degree angle on the side that the nerve was removed.
- A vein that collects blood from your brain, face, and neck. Removing this vein on one side of your neck won’t cause any problems. Other veins in your neck will collect and circulate the blood on that side of your neck and face.
- A salivary gland in the upper part of your neck. Removing this gland won’t cause any damage to your salivary function.
Once your lymph nodes have been removed, your surgeon will close your incision with staples or sutures (stitches). The type of incision line you have will depend on which lymph nodes and structures were removed. Your surgeon will discuss this with you.Back to top
Before Your Surgery
Preparing for Your Surgery
You and your healthcare team will work together to prepare for your surgery.
Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.
- I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox®), dabigatran (Pradaxa®), apixaban (Eliquis®), and rivaroxaban (Xarelto®). There are others, so be sure your doctor knows all the medications you’re taking.
- I take prescription medications, including patches and creams.
- I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia (medication to make you sleep during surgery) in the past.
- I have allergies, including to latex.
- I am not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke.
- I use recreational drugs.
About Drinking Alcohol
The amount of alcohol you drink can affect you during and after your surgery. It’s important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.
- Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medication to help prevent them.
- If you use alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
Here are things you can do to prevent problems before your surgery:
- Be honest with your healthcare provider about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or can’t sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you can’t stop drinking.
- Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.
People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program at 212-610-0507.
About Sleep Apnea
Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, the airway becomes completely blocked during sleep. It can cause serious problems during and after surgery.
Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.
Within 30 Days of Your Surgery
Presurgical Testing (PST)
Before your surgery, you will have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.
You can eat and take your usual medications the day of your PST appointment. During your PST appointment, you will meet with a nurse practitioner (NP) who works closely with anesthesiology staff (doctors and specialized nurses who will give you anesthesia).Your NP will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your NP may also recommend you see other healthcare providers.
Your NP will talk with you about which medications you should take the morning of your surgery.
It’s very helpful if you bring the following with you to your PST appointment:
- A list of all the medications you’re taking.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram (echo), or carotid doppler study.
- The name(s) and telephone number(s) of your doctor(s).
Health Care Proxy
If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you’re unable to communicate for yourself. The person you identify is called your health care agent.
If you’re interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advance directive, bring it with you to your next appointment.
Breathing and Coughing Exercises
Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, read How to Use Your Incentive Spirometer. If you have any questions, ask your nurse or respiratory therapist.
Try to do aerobic exercise every day, such as walking at least 1 mile, swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping market. Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier.
Eat a Healthy Diet
You should eat a well-balanced, healthy diet before your surgery. If you need help with your diet, talk to your doctor or nurse about meeting with a dietitian.
10 Days Before Your Surgery
Stop Taking Vitamin E
If you take vitamin E, stop taking it 10 days before your surgery, because it can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
7 Days Before Your Surgery
Stop Taking Certain Medications
If you take aspirin, ask your surgeon if you should continue. Aspirin and medications that contain aspirin can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Stop Taking Herbal Remedies and Supplements
Stop taking herbal remedies or supplements 7 days before your surgery. If you take a multivitamin, ask your doctor or nurse if you should continue. For more information, read Herbal Remedies and Cancer Treatment.
Watch a Virtual Tour
This video will give you an idea of what to expect when you come to MSK’s main hospital on the day of your surgery.
2 Days Before Your Surgery
Stop Taking Certain Medications
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®), and naproxen (Aleve®). These medications can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
1 Day Before Your Surgery
Note the Time of Your Surgery
A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. The clerk will tell you what time you should arrive at the hospital for your surgery. If you’re scheduled for surgery on Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call 212-639-5014.
The clerk will tell you where to go on the day of your surgery. Both locations are at 1275 York Avenue between East 67th and East 68th streets.
Go to bed early and get a full night’s sleep.
- Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.
- Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).
- Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.
The Morning of Your Surgery
Take Your Medications
If your doctor or NP instructed you to take certain medications the morning of your surgery, take only those medications with a small sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.
Things to Remember
- Don’t put on any lotion, cream, deodorant, makeup, powder, or perfume.
- Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Leave valuables, such as credit cards, jewelry, or your checkbook, at home.
Before you’re taken into the operating room, you will need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles.
If you wear contact lenses, wear your glasses instead.
What to Bring
- A button-down or loose fitting top.
- Your breathing machine for sleep apnea (such as your CPAP), if you have one.
- Your incentive spirometer, if you have one.
- Your cell phone and charger.
- Only the money you may need for a newspaper, bus, taxi, or parking.
- Your portable music player, if you choose. However, someone will need to hold it for you when you go into surgery.
- A case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles, if you have it.
- Your Health Care Proxy form, if you have completed one.
- This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
Parking When You ArriveMSK’s parking garage is located on East 66th Street between York and First Avenues. If you have questions about prices, call 212-639-2338. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that connects the garage to the hospital.
There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Once You’re in the Hospital
You will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having surgery on the same day.
Get Dressed for Your Surgery
When it’s time to change for surgery, you will get a hospital gown, robe, and nonskid socks to wear.
Meet With Your Nurse
You will meet with your nurse before surgery. Tell your nurse the dose of any medications (including patches and creams) you took after midnight and the time you took them. Your nurse will insert an intravenous (IV) line into a vein , usually in your arm or hand. The IV line will be used to give you fluids and anesthesia during your surgery.
Meet With Your Anesthesiologist
- Review your medical history with you.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia you will receive.
- Answer any questions you may have about your anesthesia.
Prepare for Surgery
Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to begin. When it’s time for your surgery, your visitor(s) will be shown to the waiting area. Your visitors should read Information for Family and Friends for the Day of Surgery.
You will either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help circulation in your legs.
The length of your surgery depends on which type of surgery and incision you have. Your doctor will discuss this with you before your surgery. Once your surgery is finished, your incisions will be closed with staples or sutures.Back to top
After Your Surgery
What to Expect
When you wake up after your surgery, you will be in the Post Anesthesia Recovery Unit (PACU). Your visitors can visit you briefly in the PACU, usually within 90 minutes after you arrive there. A member of the nursing staff will explain the guidelines to them.
You will receive oxygen through a thin tube that rests below your nose called a nasal cannula. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels. You will also be wearing compression boots to help your circulation.
Depending on the amount of lymph nodes removed, you may have a drain called a ReliaVac®. The ReliaVac drain will be placed in your neck during your surgery. It helps prevent fluid from collecting under your skin (see Figure 2). The drain doesn’t hurt. It will be emptied regularly.
Depending on the type of surgery you had, you may stay in the PACU overnight. After your stay in the PACU, you will be taken to your hospital room.
Commonly Asked Questions: During Your Hospital Stay
Will I have pain?
You will have some pain after your surgery. Your doctor and nurse will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, please tell your doctor or nurse.
You will first get pain medication through your IV. You will get pain medication by mouth once you are eating a regular diet. You will be given a prescription for pain medication before you leave the hospital.
How can I prevent constipation?
Prescription pain medication may cause constipation. Your doctor may prescribe medication to prevent constipation for you to take while you’re at home recovering from surgery. There are also other things you can do to prevent constipation, such as:
- Exercise, if you can. Walking is an excellent form of exercise.
- Drink plenty of liquids. Aim for 8 to 10 (8-ounce) glasses each day. Drink water, juices, soups, ice cream shakes, and other drinks that don’t have caffeine. Drinks with caffeine, such as coffee and soda, pull fluid out of the body.
- Go to the bathroom at the same time every day. Your body will get used to going at that time. Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time, because the reflexes in your colon are strongest at this time.
- If you feel the urge to go, don’t put it off.
If these methods don’t help, talk with your doctor or nurse. They may recommend over-the-counter or prescription medication.
When can I eat?
For the first meal after your surgery, you will get clear liquids. If you can tolerate that (or if you’re not experiencing nausea), your diet will then progress to solid food.
When will my ReliaVac drain be removed?
Your ReliaVac drain will be removed when the amount of drainage is steadily decreasing and the output is less than 25 to 30 milliliters (about ½ ounce) in 24 hours. This is usually 3 to 5 days after surgery.
When will my staples or sutures be removed?
If you stay in the hospital for longer than 1 week, some or all of your staples or sutures may be removed before you leave.
If you stay in the hospital for less than 1 week, your staples or sutures will be removed during your post-operative visit (your first follow-up visit with your doctor after your surgery).
If you had radiation therapy to the neck before your surgery, your staples or sutures may stay in place for 2 to 3 weeks.
How long will I be in the hospital?
Your doctor or nurse will give you an estimate of how long you will be in the hospital. Most people are discharged on the day that their ReliaVac drain is removed. This is usually 3 to 5 days after surgery.
Some people may go home with the drain in place. If this is the case, your nurse will teach you how to care for it before you leave the hospital.
Commonly Asked Questions: After You Leave the Hospital
Will I have pain when I am home?
The length of time each person has pain or discomfort varies. Follow the guidelines below to manage your pain.
- Call your doctor if the pain medication prescribed for you doesn’t relieve your pain.
- Don’t drive or drink alcohol while you’re taking prescription pain medication.
- Pain medication should help you as you resume your normal activities. Take enough medication to make sure you can gradually increase your activities. Pain medication is most effective 30 to 45 minutes after taking it.
- Keep track of when you take your pain medication. Taking it when your pain first begins is more effective than waiting for the pain to get worse.
As your incision heals, you will have less pain and need less pain medication. A mild pain reliever such as acetaminophen (Tylenol®) or ibuprofen (Advil®) will relieve aches and discomfort.
How do I care for my incision?
It’s very important that you keep your incision clean and remove any crust that develops on it. Crust can collect bacteria and lead to infection. Your doctor or nurse will teach you how to care for your incision before you’re discharged. Once you’re home, you must care for your incision daily as described below.
- Gather the following supplies:
- Cotton swabs (such as Q-Tips®)
- Normal saline
- Bacitracin ointment
- Wash your hands thoroughly with soap and water or use an alcohol-based hand sanitizer such as Purell®.
- Take a cotton swab and dip it in the normal saline.
- Use the cotton swab to gently clean along the incision line around the staples or sutures. This will help loosen any crust that may have developed along the wound.
- Throw the swab away.
- Repeat the steps above with a fresh swab as many times as it takes to clean the incision line. Remember that you can only dip the swab once. You must use a clean swab each time you dip it into the saline.
- Apply a small amount of bacitracin ointment to the incision line with a clean cotton swab.
When can I shower?
You can shower 24 hours after your drain is removed from your neck. When showering, don’t let the water from your shower head hit your incision directly. Rather, allow the soap and water to run over your incision. Gently pat your incision dry with a clean towel.
What do I need to do to recover from my surgery?
After your sutures or staples are removed, your doctor or nurse may instruct you to do certain exercises every day. This will depend on how well you can turn your neck and move your arm(s) after surgery. The exercises will help you regain full range of motion and strength to the affected area(s). It’s important that you do them every day. Your doctor or nurse will show you how to do the exercises and will give you written instructions at your post-operative visit.
When can I resume my normal activities?
Your doctor and nurse will tell you when you can resume your normal activities during your post-operative visit. Until then, avoid all activity that could put strain on your incision, including:
- Lifting items heavier than 10 pounds (4.5 kilograms)
- Vigorous exercise
- Sexual activity
When can I resume sexual activity?
Ask your doctor or nurse when you can resume sexual activity.
What type of follow-up care will I receive after I leave the hospital?
You will have your post-operative visit with your doctor about 1 week after you’re discharged from the hospital. Until then, be sure to follow all instructions given to you when you were discharged.
If you have any questions or concerns, you can contact your doctor’s office at any time after you have been discharged from the hospital.
When will I get my test results?
The lymph nodes will be examined for cancer after they’re removed. The test results are usually ready in 5 to 7 business days. Based on the results, you may need further treatment. Your doctor will discuss the results with you during your post-operative visit.
How can I cope with my feelings?
After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, or angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support.
The first step in coping is to talk about how you feel. Family and friends can help. Your nurse, doctor, and social worker can reassure, support, and guide you. It’s always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Many resources are available to patients and their families. Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness.Back to top
Call Your Doctor or Nurse if You Have:
- A temperature of 100.4 °F (38 °C) or higher
- Increased discomfort, redness, or both around your incision line
- Skin around the incision line that’s hot to the touch
- Drainage or accumulation of fluid from the incision site
- Shortness of breath
- New or increased swelling around your incision
Call with questions about anesthesia.
Blood Donor Room
Call for more information if you’re interested in donating blood or platelets.
Bobst International Center
MSK welcomes patients from around the world. If you’re an international patient, call for help arranging your care.
At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital, and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.
Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed.
Integrative Medicine Service
Integrative Medicine Service offers patients many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.
Patient-to-Patient Support Program
You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, we are able to offer you a chance to speak with former patients and caregivers.
Call Patient Billing with any questions regarding preauthorization with your insurance company. This is also called preapproval.
Patient Representative Office
Call if you have any questions about the Health Care Proxy Form or if you have any concerns about your care.
Perioperative Nurse Liaison
Call if you have any questions about MSK releasing any information while you are having surgery.
Private Duty Nursing Office
Patients may request private nurses or companions. Call for more information.
Resources for Life After Cancer (RLAC) Program
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also help referring you to community agencies and programs, as well as financial resources if you’re eligible.
Tobacco Treatment Program
If you want to quit smoking, MSK has specialists who can help. Call for more information.
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who are unable to take the public bus or subway.
Cancer and Careers
A comprehensive resource for education, tools, and events for employees with cancer.
275 Seventh Avenue (Between 25th & 26th Streets), New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.
Cancer Support Community
Provides support and education to people affected by cancer.
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance,meet the income criteria, and be prescribed medication that is part of the Good Days formulary.
LGBT Cancer Project
Provides support and advocacy for the LGBT community, including a online support groups and a database of LGBT friendly clinical trials.
National Cancer Legal Services Network
Free cancer legal advocacy program.
National LGBT Cancer Network
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.
Lists Patient Assistance Programs for brand and generic name medications.
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.
Patient Advocate Foundation
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.
- Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- Herbal Remedies and Cancer Treatment
- How to Use Your Incentive Spirometer
- Information for Family and Friends for the Day of Surgery