Radical Neck Dissection

When cancer cells of the neck and head grow and multiply, they can spread (metastasize). Usually the first place to which they metastasize is the lymph nodes in your neck. Your lymph nodes are oval-shaped organs that help filter toxins and dead cells from your body. Your lymph nodes are linked through a network of lymph vessels. From the lymph nodes, cancer cells can metastasize through the lymph vessels to other other parts of your body.

Radical neck dissection is surgery to remove lymph nodes and other structures in your neck that have become or are thought to have become cancerous (malignant). The goal of this surgery is to remove all of the cancer and prevent the cancer from metastasizing to other parts of your body, while preserving as much of the function and normal appearance of the neck as possible. Radical neck dissection is not done if cancer has metastasized to other parts of your body.

Other structures in your neck, in addition to lymph nodes, that may be removed during radical neck dissection include:

  • The sternocleidomastoid muscle. This muscle goes from your upper chest to the back of your skull. It gives your neck its shape and helps you to flex your head. Very little function is lost when it is removed.

  • The jugular vein. A large chain of lymph nodes surround this vessel. This vein drains blood from your head.

  • The submandibular gland. This gland is under the jaw and makes saliva. You have other salivary glands, so you will only notice a slight change in the amount of saliva that you produce after this gland is removed.

  • The spinal accessory nerve. This is a nerve that helps you control speech, swallowing, and certain movements of your head and neck. After this nerve is removed, your shoulder will droop and your arm movement above 90 degrees will be limited.

LET YOUR CAREGIVER KNOW ABOUT:

  • Any allergies you have.

  • All medicine you take, include vitamins, herbs, eyedrops, over-the-counter medicines, and creams.

  • Any problems you have had with numbing medicines (local anesthetics) or medicines that make you sleep (general anesthetics).

  • Any blood disorders you have.

  • Any surgeries you have had.

  • Any other health problems you have.

RISKS AND COMPLICATIONS

There are certain risks that are associated with all major surgeries: allergic reaction to the general anesthetic, bleeding, and infection. However, there are specific risks associated with radical neck dissection.

The greatest risks associated with radical neck dissection are damage to nerves and blood vessels in your neck. Injury to your carotid artery can lead to stroke. If you have a vascular disease and your jugular vein is removed during the procedure, you may have facial swelling after the procedure. Nerve damage can result in numbness and loss of function to your face, tongue, neck, throat, and shoulder. This damage and loss of function can be either temporary or permanent. Specific examples include:

  • Weakness of facial muscles.

  • Hoarseness.

  • Difficulty swallowing.

  • Numbness in your tongue.

  • Loss in movement of your tongue.

BEFORE THE PROCEDURE

Do not eat or drink anything after midnight on the night before your procedure. Your caregiver will tell you if you need to stop taking any of your regular medicines or adjust your dosage. Your caregiver may have the following tests performed to make sure you are ready for surgery:

  • Blood tests.

  • Chest X-ray exams.

  • Electrocardiography. This procedure measures the electrical activity of your heart. Electrocardiography is performed to make sure that your heartbeat is consistent.

  • Imaging exams, such as computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI). These exams help your caregiver to understand how extensive your cancer is and whether it has metastasized to other parts of your body.

PROCEDURE

Radical neck dissection takes between 2 hours and 4 hours to complete, depending on the location of the cancer and the lymph nodes involved. You will receive a general anesthetic through an intravenous line (IV) that will be placed in your hand or arm. You will also receive fluids and medicines through this tube during your procedure and for 1 day or more after the procedure.

Once you are asleep, the surgeon will make a long cut (incision) on one side of your neck, from just above your collarbone to just below your jawbone. Other smaller incisions may also be needed. Muscles that do not need to be removed will be carefully moved aside. Care is taken to protect your nerves and blood vessels during the procedure. The malignant lymph nodes and other malignant structures are removed.

One or more plastic drains may be inserted at the bottom of your neck. Suction bulbs will be attached to catch the excess blood and other fluids that will drain from your incision after the procedure. The surgeon will close the incision with stitches or staples and cover the incision and drainage area with a bandage (dressing).

AFTER THE PROCEDURE

You will be taken to a recovery area until the anesthetic wears off. Then you will be taken to a hospital room. The typical hospital stay after radical neck dissection is between 2 days and 5 days.

When you can drink again, your IV will be removed. Soon after that, you will be able to begin eating food. The drains will stay in for several days. Your caregivers will empty the bulbs. The drains can come out when no more fluid is draining. Some people go home with the drains still in. If you do, your caregiver will show you how to take care of them at home. Stitches or staples used to close your incision will stay in for about 1 week.