The lymphatic system is part of our body’s immune system. It contains a network of lymph vessels and lymph nodes. Lymph nodes are small bean-shaped organs that act as filters for foreign substances including infections and cancer cells. Lymph nodes are connected via a network of vessels called lymphatics (or lymph vessels). These lymph vessels carry a fluid called lymph, which carries white blood cells which help to fight off infections.
Many kinds of cancers can spread via lymph vessels and involve the lymph nodes. For cancers in the head and neck region, these cancers can often spread to the lymph nodes in the neck.
A neck dissection is an operation where the surgeon will remove lymph nodes and the surrounding tissue from the neck. Your doctor may discuss doing a neck dissection operation with you if there is proven cancer in the lymph nodes or he feels that your cancer has a high risk of spreading to the lymph nodes. There are different types of neck dissections. The exact type of neck dissection that will need to be done will usually depend on where the cancer is located and whether or not it has spread to the lymph nodes in your neck or has also involved the other structures in your neck. Your doctor will discuss with you the type of neck dissection that needs to be done. The neck dissection is often only one part of the surgery, and very often surgery to treat the primary site of the tumour will also be necessary.
A neck dissection is performed under general anesthesia with you asleep. A cut in the skin is made in the side of the neck and during the operation the surgeon will remove the fatty tissues of the neck containing the lymph nodes while leaving the important structures behind.
Common incisions used for a neck dissection.
1. Numbness of the skin of the neck, lower face and ear. Many patients find that the skin over these areas are numb after the surgery. This is because many of the superficial nerves that supply the skin are disrupted during the surgery. The numbness does improve over time to some extent, but it often does not return back to normal. 2. Shoulder stiffness/weakness. Some patients may have stiffness or weakness of their shoulder after the surgery, especially when it comes to lifting the arm above their head (abduction). This is because the spinal accessory nerve, which is the nerve that supplies one of the muscles that moves your shoulder, is affected by the surgery. In cases where the cancer is invading into the nerve, the nerve may even need to be removed together with the lymph nodes. Your doctor will get a physiotherapist to work with you on shoulder exercises to strengthen the other shoulder muscles to prevent any weakness of the arm movement.3. Injury to the marginal mandibular nerve This is a small branch of the facial nerve that runs just below the level of your jaw in the neck and controls movement of the lower lip. It is at risk during the surgery due to its position and your surgeon will usually try to preserve it. However, if it is damaged, patients may find the corner of the mouth a little weak and they may have asymmetrical movement of the corner of their mouth on one side, usually most noticeable on smiling.Course of the marginal mandibular nerve(shown in yellow). 4. Bleeding Some patients may have bleeding after their surgery.
Bleeding under the skin after a neck dissection is not common but when it happens your doctor may need to bring you back to the operating room to stop the bleeding and remove the blood collected under the skin. 5. Chyle leak This happens mainly on neck dissections done on the left side of the neck from disruption of a structure called the thoracic duct which lies low in the neck on the left side. If this happens, a fluid called chyle can leak out from the thoracic duct and collect in the neck. This is treated in restricting the fat content in your diet to reduce the chyle fluid production. You may also have a dressing applied over the neck to reduce the collection. This often can be resolved without surgery but in some patients they may need another surgical procedure to stop the leak. 6. Wound infections and complications Wound infections can occur after any surgery but is uncommon after head and neck surgery. 7. Changes in speech and swallowing (rare) There are important nerves in the neck which help to move your tongue (hypoglossal nerve) and vocal cords (vagus nerve). In rare instances injury to these nerves may occur and will result in changes in your speech and swallowing which may necessitate a period of rehabilitation or further surgery to improve the function.
Your doctor may decide put a surgical drain in your neck at the time of surgery. This is a tube placed to remove excess fluid to prevent it from collecting in your neck. The nurses will teach you how to care for the drain and how to measure the output of the drain. Your doctor will remove the drain once the amount coming out every day is minimal.
Wound CareIt is alright to shower with soap and water but avoid scrubbing or excessive pressure over your surgical wound in your neck. After showering, pat the wound dry gently with a towel but do not rub the wound forcefully.
Physical Activity
Your doctor will usually arrange for a physiotherapist to work with you for mobilization exercises. It is important for you to co-operate with them and do follow their exercises as this will help to give you the best functional outcomes and recovery after surgery. Pain medication Your doctor will usually prescribe you some medication to help with any pain you might have after the surgery. Take your medication as advised by your doctor. If you continue to have significant pain despite taking the medication, let your doctor or nurse know.
Seek medical attention if you have any of the following:
