A tumour can spread from its original site via the lymphatic drainage system to regional lymph nodes. The aim of this operation is to remove the regional lymph nodes in your neck, along with the surrounding fatty and connective tissue, and any tumour which has developed in them. Sometimes it is necessary to remove the parotid gland as well, which is a small organ that produces saliva found in front of the ear.
The operation is performed under general anaesthetic which means you will be fully asleep during the entire operation. The anaesthetist will see you before your operation so you can discuss any queries you may have about the anaesthetic.
If you have had any difficulties during a general anaesthetic in the past, make sure both the anaesthetist and the ward doctor are aware of them
What does the surgery involve?
A large incision is made to gain access to the lymph nodes in the neck. Once the lymph nodes have been removed the flap of skin is replaced with stitches or clips.
After Your Operation
On the evening after your general anaesthetic you will feel rather tired and sleepy and should warn your visitors that you may not be very good company!
At the end of the operation a number of tubes are placed through the skin into the wound to drain any blood which may collect. These usually stay in place for a couple of 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 completely disappear.
It is necessary to make sure that the incisions heal without any infection and so you will be given antibiotics through a vein in your arm whilst you are in hospital. You will also be given regular painkillers.
The skin stitches or clips will be removed around a week following surgery.
The skin of your neck will feel numb for several months after surgery as a result of bruising to the nerves.
Any operation can give problems with infection or bleeding. Simple infections will settle with skin treatment others through a course of antibiotics but some infections go on to form an abscess which may need a further operation.
If you notice increasing redness of your wound or it is painful, tell a doctor as soon as possible as infections caught early are easier to treat.
What are the possible problems?
There are potential complications with any operation. Fortunately with this type of surgery complications are rare and may not happen to you. However it is important that you are aware of them and have the opportunity to discuss them with your surgeon. Most of the problems associated with neck dissection are the result of damage to one of two nerves:
Accessory nerve – this is a nerve which runs from the top to the bottom of the neck and helps you to move your shoulder. The nerve has lots of lymph glands lying very close to it and so it is often bruised during a neck dissection. If the nerve is bruised it can stop working for several months. If this happens you may experience pain and some difficulty in moving your shoulders which makes getting dressed less easy. Rarely the lymph nodes cannot be completely removed without cutting this nerve. Should this be the case then these shoulder problems will be permanent.
Facial nerve – the branch of the facial nerve which makes your lower lip move can be bruised when the lymph nodes close to it are removed. If this happens then the lower lip doesn’t move properly and you may end up with a weakness which results in a crooked smile. The majority of these get better on their own but can take several months to improve fully.
Haematoma – This is the name given to a collection of blood that has formed a blood clot around the site of the operation. This may be treated in 1 of 2 ways.
- a. If small it may be left to be reabsorbed by your body’s normal defences.
- b. It may be necessary to return to the operating theatre to find the area it is bleeding from and to seal the area from further bleeding and to remove the clot of blood.
Chyle Leak – Major Lymph channels are encountered at the lower aspect of the neck, especially on the left side. These are carefully tied off to prevent lymph drainage into the wound. Occasionally a lymphatic leak occurs despite these efforts. Food in the stomach can increase the amount of lymphatic flow. A diet change and a pressure dressing can usually control this problem, but return to the operating room may be required for repair.
Have I got cancer in my lymph nodes?
It is often not possible to tell this until after your operation when the glands removed from the neck are carefully looked at under a microscope. Your doctor will have already felt your neck to see if there are any lumps and you might have had a special scan (CT or MRI) to look more closely at the glands. Glands can feel big if there is infection in the area, so if you can feel a lump in your neck it does not necessarily mean that the cancer has spread. If there is only a small amount of cancer cells present in the glands then the neck can feel normal and look normal on scan. This is often why we do not know if the cancer has spread to the neck until the glands have been looked at under a microscope.
Will I need to have further treatment after my neck dissection?
Hopefully not but this depends on what is found when the lymph nodes are looked at under a microscope. It takes several weeks to look at the lymph nodes properly so your doctors will not know until then whether additional treatment is necessary to help cure you of your cancer. Any additional treatment usually involves specialised X-ray treatment in the form of radiotherapy.
Once your drains have been removed and you are up and about and feeling well you will be able to go home. This is usually within a week.You may be sent home with your drains in and the nursing team will inform you about what to do with them.
Before you leave the ward you will be given an appointment for the dressing clinic. Any stitches you have will be removed at this appointment and your wound will be checked and your dressing changed. You will also be given an outpatient clinic appointment.
To start with you will feel rather tired and you should spend the first week or so taking it easy. After that you will be able to build slowly up to doing your usual activities.
You will be able to start driving once you feel up to it and you are able to perform an emergency stop comfortably. For most people this will take about 4 weeks. Do not drive if you are not well, alert and able to take emergency action. It is advisable to check with your insurance company before you start driving again.
Return to Work
You will be able to start work again once you feel up to it but if your job involves a lot of lifting or heavy work this will take longer. Speak to your GP who will give you a sick certificate to cover until you are fit to go back to work.