Not all neck dissections are the same. In fact the procedure has evolved greatly over recent years to reduce the side effects for patients whilst maintaining the same level of effectiveness. This means that some of the information for patients that is available is outdated.

Neck dissections are carried out under general anaesthetic and are performed to remove the lymph glands in the neck at risk from having cancer cells inside them. This is often performed as part of a bigger procedure including for example the removal of a mouth tumour.

Investigations which will have normally been performed include a combination of CT Scan, MRI or Ultrasound.

There are literally hundreds of small lymph glands contained in the neck in a deep fatty layer. These can act as a pathway of cancer spread.

Selective neck dissection

In this procedure only the lymph glands most at risk of harbouring cancer cells for a particular tumour are removed. There has been lots of research demonstrating which areas or levels of the neck are most at risk and these are the ones targeted by this procedure.

Whilst the main aim of the procedure is to remove the lymph glands, your surgeon will also be taking great care to protect and preserve all of the other structures in the neck, such as important nerves to the lips, tongue, and shoulders.

Selective neck dissections are performed for cancers considered to be at significant risk of spread to the neck, despite no evidence of spread on the imaging and examination. This is because even the most accurate of modern day imaging can not detect microscopic cancer cells in the lymph glands.

Previously some surgeons would advocate a “watch and wait” approach to this clinical situation but a large trial recently confirmed that patients who had a selective neck dissection had a significant survival advantage when compared with patients who were closely monitored.

http://www.nejm.org/doi/full/10.1056/NEJMoa1506007

Procedure

During the procedure a cut or incision is made in the neck in a crease or wrinkle starting from roughly between the ear and the back of the jaw and extending towards the midline.

This gives the surgeon access to the lymph glands at risk and tends to heal with an inconspicuous scar.

The surgeon will then proceed to carefully remove the glands inside the neck at risk of spread whilst doing their upmost to preserve the small nerves and vessels inside the neck which are responsible for lip, shoulder and tongue movement.

The lymph glands are then sent to the pathologists who will examine for any sign of cancer spread. The results are usually available around 7 days after surgery.

The procedure usually takes between 60 and 90 minutes to complete. After which a drain is placed in to the neck wound. This is to prevent fluid collecting during the initial healing period.

The neck wound is then carefully closed to minimise scarring. Patients are usually in a position to eat and drink straight away after the procedure and on average will stay in hospital 2-3 days. Usually patients feel well enough to go home sooner but often the drain will need to stay in that period of time.

A follow up will be arranged in clinic around a week later and normally the results are available at that time.

Elective Neck Dissection

Risks

Pain

Patients are normally warned about experiencing some pain and discomfort postoperatively. Our specialist head and neck anaesthetists have guided hundreds of patients safely through these procedures and will ensure that this is kept to a minimum. Actually it is our observation that patients do not normally experience much pain after this procedure.

Infection

A neck dissection is usually classed as clean surgery. Best practice is adopted to reduce the risks of wound infection and antibiotics are given during your operation and several post op doses are usually given too.

Shoulder pain and dysfunction

One of the nerves that supplies several of the muscles that contribute to shoulder function is at risk during neck surgery ( Accessory Nerve). Your surgeon will take great care to preserve this nerve but even when fully intact patients can experience some shoulder stiffness and sometimes pain. Specialist physiotherapy will be prescribed to help this return to normal.

Lip weakness

There is a small nerve which runs near the border of the lower jaw which contributes to moving the lower lip. Care will be taken to preserve this nerve and it will be held out of the way. Sometimes patients will experience temporary weakness of this nerve which will make the smile slightly asymmetrical. This usually then recovers over the course of several months. This can on rare occasions however be permanent.

Tongue numbness and weakness

The nerves which supply feeling and movement to the tongue are at risk during neck surgery. It is very rare in the context of a selective neck dissection for this to be an issue. If the sensory nerve (Lingual nerve) is injured then there would be a sensation of pins and needles or no sensation at all on the affected side of the tongue.

If the nerve responsible for movement (Hypoglossal nerve) is injured then the tongue wont move well on the injured side. Fortunately permanent nerve injuries like this are rare and actually patients usually adapt if the other side is working well.

Haematoma

This is a collection of blood under the skin ( a bit like a big bruise) which accumulates in the space where the glands were. We aim to avoid this by using drains but it can still happen. It is more common in patients taking blood thinning tablets and usually requires a return to theatre to drain it.

As with all patients undergoing surgery there are also risks of blood clots in the legs (DVT) or chest (PE) and so patients will be given special surgical stockings and blood thinning injections.