Neck Dissection

In the neck, as in other areas of our body, there are lymph nodes – nodes that have an important role in the function of the immune system. The neck actually contains several hundred such nodes. Their role includes protecting the body against threats that enter from the area of the nose, ear, and throat (inflammation, viruses, etc.).

The lymph nodes are also among the first structures to be attacked when a cancerous tumor is spreading. The metastases that spread from the tumor towards nearby structures reach these nodes, which are comparable to central intersections in the body, and from there they spread easily via the lymphatic system.

The suspected spread of cancer in the region of the neck, or a risk that such a situation could develop in the future, will lead to a decision to carry out neck dissection – an operation to remove the lymph nodes from the neck, in order to prevent the spread of the tumor.

General information about the procedure

As stated above, neck dissection is a surgical procedure during which lymph nodes are removed from the neck, in order to prevent the spread of cancer that is located nearby to other organs of the body. The very removal of the nodes makes it more difficult for cancer to spread, thus. This procedure can thus help to treat the disease and even to make it less dangerous.

In the past, neck dissection operations were almost always performed only by an approach called radical neck dissection, in which the lymph nodes were removed, and together with them, adjacent tissues and organs, such as muscles, veins, nerves, etc. were also removed. For this reason, it could carry many implications after the operation, such as limitations in movement and significant esthetic impairment at the site of the operation. This procedure is still performed sometimes, but is very rare, and is only performed when the cancerous tumor has spread very much.

Most neck dissection procedures performed today are selective dissection procedures, in which the nodes themselves are removed, but the tissues and structures adjacent to them are preserved and not damaged, so far as possible. Even the scar created by the operation is not as obvious is in the past.

Preparing for the procedure

Neck dissection is performed under general anesthesia, so it is necessary to fast for about 6 hours before the operation. Apart from that, in the days leading up to the operation, you will undergo imaging examinations (such as head CT), in order to assess the condition of the lymph nodes and to decide exactly how many will be removed, and from where.

The course of neck dissection

After you are anesthetized, the physician will make a careful incision in your neck. The incision will be made in one of the skin folds in your neck, so that the scar will be well concealed and will not be prominent after the operation. For this reason, the incision made will be across the breadth, not up the length of the neck. After the incision, the physician will remove the lymph nodes whose removal was decided upon. These may be affected by lymph nodes in which cancerous cells have been discovered or lymph nodes at reasonably high risk of having cancer spread to them in the foreseeable future.

Thus, for example, tongue cancer will usually lead to a decision to perform neck dissection, as this type of cancer tends to spread to the lymph nodes in the neck. Other types of cancer that are also considered, for this reason, to be similarly at risk are salivary gland cancer, parathyroid cancer, oropharyngeal cancer, nasopharyngeal cancer, and throat cancer. Tumors of the head and brain can also spread via the lymph nodes in the neck.

In the framework of the operation, depending on the degree to which cancer has spread, a decision will be made regarding the removal of additional tissues or organs, such as the salivary gland in the upper neck. Any such decision will be made after due consideration, not automatically, in order to reduce damage to healthy tissue as much as possible and to prevent far-reaching implications of the operation for your body.

Discharge from the hospital will usually be about 48 hours after the operation at the most. A special drainage tube will usually be placed in the operated area, to allow the emptying of fluid that accumulates in the neck after the operation. It will be removed a few days later. You may need various physiotherapy treatments after the operation in order to preserve a normal range of motion of the neck and shoulders.
Neck dissection usually takes between one-and-a-half hours and two hours, but not infrequently, it will be performed in the framework of a broader operation to remove cancerous tumors from the head and neck area, for example. In such a case, the entire procedure will, of course, take more time.

side effects

Since radical neck dissection is almost never done in recent years (except in cases of the very wide spread of cancer), severe side effects are quite rare. They are mainly connected to the extent of the injury to tissues and organs adjacent to the lymph nodes and may manifest as impaired shoulder movement, damage to the nerves of the tongue and damage to the nerve that innervates the lower lip.