Sections from “About Your Neck Dissection Surgery”

This information explains your neck dissection surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.

This resource does not include information about how to prepare for your neck dissection surgery. For information about how to prepare for surgery, please see our full length guide, About Your Neck Dissection Surgery.

About Your Surgery

Levels of lymph nodes

Head and neck cancer can spread to the lymph nodes. Lymph nodes are small oval or round bodies along the lymphatic system (see Figure 1). If your doctor thinks that there is 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 is not 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 the 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 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. 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 affected side.
  • A major vein that collects blood from the brain, face, and neck. Removing this vein on one side of your neck will not 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 the neck. Removing this gland will not 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.

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 stitches.

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What to Expect After Your Surgery

After your surgery, you will be taken to the Post Anesthesia Recovery Unit (PACU). Your visitors can visit you in the PACU after your surgery. You will be moved from the PACU to your hospital room the morning after your surgery.

While you are in the PACU, a nurse will be monitoring your pulse, blood pressure, and breathing. You will also be wearing boots that squeeze and release your legs to help your circulation during and after surgery.

ReliaVac® drain in your neck

You will have a drain called a ReliaVac®, which will be placed in your neck during your surgery. It helps prevent fluid from collecting under your skin (see Figure 2). The drain does not hurt. It will be emptied regularly. When the drainage is less than 15 mL or ½ ounce, the drain will be removed. You will be discharged on the day the drain is removed.

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Common Questions

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. On average, patients stay for 3 to 5 days.

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 is not relieved, please tell your doctor or nurse.

You will first get pain medication through your IV. You will be given 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.

Will I have pain when I am home?

The length of time each patient 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.
  • Do not drive or drink alcohol while you are 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. It will not be as effective if you allow your pain to increase. 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 can I prevent constipation?

Pain medication may cause constipation, but there are steps you can take to prevent it, including exercising if you can. Walking is an excellent form of exercise. Drink plenty of water.

If these methods do not help, talk with your doctor or nurse. He or she may recommend over-the-counter or prescription medication.

When can I eat?

For the first meal after your surgery, you will be given 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 staples or stitches be removed?

If you stay in the hospital for longer than 1 week, some or all of your staples or stitches will be removed before you leave.

If you stay in the hospital for less than 1 week, your staples or stitches will be removed during 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 stitches will stay in place for 2 to 3 weeks.

How do I care for my incision?

It is 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 are discharged. Once you are home, you must care for your incision daily as described below.

  1. Gather the following supplies:
    • Cotton swabs (such as Q-Tips®)
    • Normal saline
    • Bacitracin ointment
  2. Wash your hands thoroughly with soap and water or use an alcohol-based hand sanitizer such as Purell®.
  3. Take a cotton swab and pour the normal saline over it.
  4. Gently clean along the incision line around the staples or stitches. The swabbing will help loosen any crust that may have developed along the wound.
  5. Throw the swab away.
  6. 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.
  7. Apply a small amount of bacitracin ointment to the incision line with a clean cotton swab.

Call your doctor or nurse immediately if you develop any of the following signs of infection:

  • 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 is hot to the touch
  • Drainage or accumulation of fluid from the incision site

When can I shower?

You can shower 24 hours after your drain is removed from your neck. When showering, do not apply direct water pressure to your incision. 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 stitches 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 is 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.

When can I resume my normal activities?

Your doctor and nurse will tell you when you can resume your normal activities during your first follow-up visit after your surgery. Until then, avoid all activity that could put strain on your incision, including:

  • Driving
  • Lifting items heavier than 10 pounds
  • Vigorous exercise
  • Sexual activity

When can I resume sexual activity?

Ask you 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 first follow-up visit with your doctor about 1 week after you are 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 are 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 first follow-up appointment after your surgery.

How can I cope with my feelings?

After surgery for a serious illness, you may have new and upsetting feelings. Many patients say they felt sad, worried, nervous, irritable, or angry at one time or another. You may find that you cannot 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 is 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 are in the hospital or at home, we are here to help you and your family and friends handle the emotional aspects of your illness.

What if I have other questions?

If you have any questions or concerns, please talk with your doctor or nurse. You can reach them Monday through Friday from 9:00 am to 5:00 pm at the numbers listed below. After 5:00 pm, during the weekend, and on holidays, please call 212-639-2000 and ask for the doctor on call for your doctor.

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 is hot to the touch
  • Drainage or accumulation of fluid from the incision site
  • Shortness of breath
  • New or increased swelling around your incision
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