Neck dissection Treatment

Neck Dissection - Treatments

How is the surgery done?

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.

What are the possible complications from surgery?

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.

Drain Care

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.

How should I take care of my surgical wound after discharge?

Wound Care
It 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.

Avoid immersing the wound in water until fully healed( e.g. swimming, soaking in a bathtub).
Avoid scratching of the wound, even if the wound becomes itchy.
Avoid smoking as this is bad for wound healing. There is no need to take any special diet or avoid any particular foods unless this has been specifically instructed by your doctor.

Physical Activity

Avoid strenuous exercise or carrying heavy loads (>10kg) for the first week after surgery.
Standing and walking is alright.
Check with your doctor when it is okay to restart strenuous exercise.

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.