This article is on Neck Dissection, a surgical procedure completed in Otolaryngology. It is intended to help inform patients, relatives of patients and health professionals. The information in the grey boxes is more technical and intended more for Health professionals that are reading this article.

Neck Dissection

Neck Levels:
Level I: Submental & Submandibular group
Primary malignancies: Lower lip, anterior tongue, floor of mouth, chin
Level II: Upper jugular nodes
Primary malignancies: Nasal cavity, pharynx, middle ear, tongue, hard palate, soft palate, tonsils
Level III: Mid jugular nodes
Primary malignancies: Retropharyngeal, pretracheal, base of tongue and tonsils.
Level IV: Lower jugular nodes
Primary malignancies: Retropharyngeal, pretracheal, hypopharyngeal, laryngeal, thyroid.
Level V: Occipital and post-auricular nodes
Primary malignancies: Post-auricular skin and nasopharyngeal.

 

What is a Neck Dissection?

Lymph nodes are small immune organs found throughout the body. Cancers in the head and neck region commonly spread first to the lymph nodes in the neck. The spread of disease to the lymph nodes can be microscopic and are not always palpable.

Neck Dissection Types
– Radical Neck Dissection (RND)
Levels I-V
IJV, CNXI, SCM
– Modified Radical Neck Dissection (MRND)
Levels I-V
Preservation of IJV, CNXI or SCM
– Selective Neck Dissection (SND)
Preservation of 1 or more levels I-V
– Extended Neck Dissection (END)
Additional structures beyond RND

 

What are the indications for a Neck Dissection?

A neck dissection is performed when the risk of cancer spread to the lymph nodes exceeds 20%. The lymph nodes are then analysed under the microscope to identify any cancer. The surgery is completed under a General Anaesthetic (an Anaesthetist will explain to you how this process will happen).

The treatment options also vary but can include one or a combination of surgery, radiation therapy and chemotherapy.

 

What happens before surgery?

You cannot eat or drink anything from 6 hours before your surgery. The anaesthetist will see you either in clinic days before the operation or on the day of surgery.

You may be asked to have routine blood tests and scans prior to your surgery. Depending on the nature of your condition, the management may be discussed in a Multi-disciplinary meeting.

If you take regular medication, some of them, in particular blood thinners may need to be stopped prior to your surgery.

 

How long is the surgery?

The length of the operation varies significantly depending on where and how extensive the disease is. It may also be combined with other procedures at the same time. A neck dissection alone can take 2 to 3 hours of operating time.

The entire process which includes pre-operation checks, anaesthesia and recovery can take most of the day.

 

What are the risks?

This is a major surgery and there are a number of associated risks.

Common risks include:
1. Nerve injury
a) Nerves which supply function to your shoulders, tongue, facial movements and breathing may be injured.
2. Injury to blood vessel
3. Chyle leak
a) A milky fluid in the drain would suggest an injury to a duct carrying the immune fluid called thoracic duct.
b) This may prolong your admission and require alterations to your diet.
4. Wound infection
a) Redness, swelling, pain or discharge around the wound may suggest an infection
b) Antibiotics is usually sufficient in treatment. However, if the infection forms a collection of pus, surgery may be needed.
5. Seroma

Nerve Injury
1. Spinal accessory nerve
2. Facial nerve
3. Hypoglossal nerve
4. Phrenic nerve
5. Brachial plexus
6. Sympathetic trunk
7. Vagus nerve
8. Lingual nerve

 

Are there alternative options?

Recommendations will depend on the indication for surgery. Your Surgeon will discuss all alternative options with you. The final decision to proceed with surgery is made by the patient.

The option of not having surgery is always available. However, in cases of head and neck cancers, this may not be recommended by your Surgical team.

In some cases radiation therapy and chemotherapy are valid treatment options for head and neck cancers.

How long is the recovery?

The recovery time is also highly variable depending on the nature of the operation. Expect to have one or more drains in the neck after the operation. The drains collect any residual oozing after surgery and are removed once the output is low.

In some cases, the patient will be monitored in a High Dependency Unit for a day or two after surgery. A urinary catheter is inserted for the surgery and is removed as soon as the patient is able to mobilise to the bathroom.

The care will be provided by the Multi-Disciplinary Team including Physiotherapy, Occupational Therapy, Dietician and Pharmacist.

Most patients with a routine neck dissection are admitted for 3 to 4 days while more complex cases may need admission for 1 to 2 weeks. Your Surgeon will discuss the expected length of stay at your clinic appointment.

It is important to avoid any heavy lifting or physical activity after discharge. Depending on your line of work, you may need to take several weeks off after discharge. Please discuss this with your Surgical Team prior to discharge to arrange for appropriate support information.

 

Further reading:

1. American Head & Neck Society – Neck Dissection
2. Medline Plus – Neck Dissection

 

References:
1. Holmes J. Neck Dissection: Nomenclature, Classification, and Technique. 2008. Oral Maxillofacial Surg Clin N Am. 20:459–475
2. Sippel R. Neck dissection for differentiated thyroid cancer. 2020. UpToDate.

 

Author + Affiliation:
Dr Johnny Wu, Department of Otolaryngology, Waikato Hospital.
Reviewed by Dr , Otolaryngologist, Waikato Hospital

Date of Publication +/- Review:
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Neck Dissection

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