Neck Dissection

Head and Neck Services Aintree

University Hospital Aintree Hospitals NHS Foundation Trust Lower Lane Liverpool L9 7AL

Head and Neck Cancer Services

Clinical Nurse Specialists 0151 529 5256

The aim of this leaflet is to provide information for you on the procedure to be carried out. It will hopefully guide you through the journey you are about to take and assist you in understanding what is to be done and the intended outcome. What is a neck dissection and why will I do I need this to be done? A neck dissection is an operation that removes lymph glands from the neck, it can be on one side or both depended on your treatment. This can be done as part of your treatment or for a diagnosis if a cause for your neck lump cannot be found. If you have a diagnosis of head and neck cancer it may be necessary to remove the lymph glands on one or both sides of your neck. This is usually done because the cancer has spread from the primary site (where it started from) in your head and neck to another site, usually the neck. This is called a metastasis or secondary cancer. On some occasions the cancer of your neck may be the only site that they can find cancer and you may just have a neck dissection without any other surgery. Lymph nodes, what are they? They are glands that are all over your body. The main job of the glands is to filter the liquid that leaks out of blood vessels called lymph. This fluid contains white blood cells whose function is to trap germs and fight infection. As part of this
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As part of your assessment, a doctor will have examined your neck and he may have felt an enlarged gland. You will have had a MRI/CT scan of your head and neck and usually a Fine Needle Aspiration (a needle into the lump to remove some cells to be looked at under the microscope) that will usually confirm a diagnosis. Occasionally it is not possible to give a definite diagnosis until after the surgery and the lump is looked at under the microscope. How will my treatment be decided The results of your examination, scans and any biopsy’s or needle tests will be discussed at a Multi disciplinary Team meeting (MDT). These are held weekly at Aintree with a team of professional that specialise in Head and Neck surgery. In the meeting there are Consultants, Radiologists(doctors who specialise in xrays), Histopathologists(doctors who examine tissue for diagnosis), Oncologist(Cancer specialists), Clinical Nurse Specialists, Allied Health Professionals(Dietician, Speech & Language Therapists). You will be seen in a clinic after the discussion and told of the best treatment options for you. It is then for you and your doctor to decide on the best one for you. What does the surgery involve?
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The position of the cut depends upon what other surgery is being done. A large cut is made to gain access to the lymph nodes in the neck. It is important to keep the skin clean and dry till it is healed to prevent any infection. position and either stitches or clips are used to hold the skin edges together. Even when they are removed as part of the surgery. you will be given painkillers move your shoulder and runs from whilst you are in and a prescription for the top of your neck to the bottom. it can start beneath the chin and extends downwards towards the collar bone then turning upwards to behind the ear. If there are only a few cancer cells in the glands they will appear normal. It has lots of lymph glands lying Leaflet Name: Leaflet Lead Name: Date Leaflet Approved Review Date Version No: Page 2 of 7 . it is usual for the skin to feel numb for several months after surgery due to bruising and cutting of superficial nerves of the skin. If there is any bleeding in the wound it can cause pressure on the windpipe and you may need an operation to stop the bleeding and remove the blood Infection of the wound – If this occurs then it may be treated with antibiotics and very rarely surgery Blood clots – This can occur in the legs as a deep vein thrombosis and can occasionally move to the lung a pulmonary embolus. You will be encouraged to get out of bed and walk around to help prevent this happening. This can cause bruising or a haematoma (collection of blood under the wound). Sometimes the cut starts from behind the ear dropping down the neck and arcing to the midline just above the breast bone.design it can also trap cancer cells that are in the body. The doctors will review you on the ward daily and dependent on the amount draining they Specific complications of the will decide when it is to be removed. A drain or small tube will be placed in your neck at the time of surgery to allow for any excess fluid that may drain from your operation site. How do you know there is cancer in the lymph nodes? Lymph glands can become enlarged due to infection such as a cold or a sore throat. Bleeding – this may be during or after the surgery. They will be removed either whilst you are in hospital or in the Community by a District Nurse. Hopefully this will return but some people are left • with a degree of numbness. Once the surgery is complete the skin is placed back to its original painkillers to control the pain. home. it will usually stay in place for 48-72 hours. • What happens after the surgery? The wound is usually numb and bruised following surgery. the remaining glands in the body will continue to fight infection for you. A neck dissection can either be carried out by itself as the treatment or at the same time as surgery to remove a cancer from the head and neck region under the same anaesthetic. The stitches or clips that have been placed to allow the skin to heal will stay in • place for 7 days. so enlarged glands do not always mean they have cancer in them. You will usually be given an injection daily to thin your blood whilst you are in hospital as a preventative measure and wear stocking to promote blood flow. operation Some discomfort and swelling is expected • Accessory nerve – this helps you after surgery. The skin is then lifted upwards to expose the lymph nodes in the neck.

the hypoglossal nerve. Liverpool. the lingual nerve. however complications can happen. Some of these can be serious and can even cause death. It is important that you are aware of any problems and that you have the opportunity to discuss them with your Consultant before the surgery takes place. If this happens you may experience reduced movement in your tongue Numbness of the skin/neck/ear – this in most noticeable to start with and gets better over weeks to months. in this case the shoulder problems will be permanent Facial nerve – the branch of the nerve that makes your lower lip move can be bruised. is rarely bruised. If this happens then you may develop a crooked smile. What are the risks to having the surgery? There are always problems that can arise when you are having surgery. All the numbers which relate to risk of surgery have been from studies of previous surgery that has taken place. The complications fall into the following categories: Complications of anaesthesia The anaesthetist will be able to discuss with you any complication that may arise General complications of surgery • Pain usually at the incision site.Before you are discharged you will be seen by a Physiotherapist who will give you some exercises to do after your drain has been removed. If this happens we usually change your diet to a fat free one to allow this tube to heal. It can sometimes prolong your in hospital and on very rare occasions mean a return to theatre for further surgery Leaflet Name: Leaflet Lead Name: • • • • close to it and can very often during surgery get bruised. combing your hair and dressing difficult. He will advise you on the frequency and you will be given an advice sheet with the instructions of the exercises to be performed. If this happens then you may experience a tingling or numb feeling Restricted tongue movement – the nerve that supplies movement to the tongue. You should always ask you doctor if there is anything you do not understand. L9 7AL Lesley Dempsey/Sally Lane 0151 529 5256 Direct line and Answerphone Monday – Friday 8am to 4.30pm Liverpool Head and Neck Cancer Date Leaflet Approved Review Date Version No: Page 3 of 7 . is rarely bruised. as a result you may experience pain and some difficulty moving your shoulder which can make shaving. If this happens it can stop working for several months. the majority get better but may take several months Numbness of the tongue – the nerve that supplies sensation to the tongue. The team will try and make your operation safe. When patients start eating again after surgery this fluid can leak out and can collect in the drains. On rare occasions the nerve may be cut as the lymph glands cannot be completely removed if this does not happen. Areas of permanent numbness can occur Useful Contacts Clinical Nurse Specialists Head and Neck Aintree University Hospitals NHS Foundation Trust Lower Lane. you will be given • Chyle leak – very occasionally a small tube carrying a fatty fluid can be damaged in the root of the neck. Your doctor may be able to tell how the risks will relate to you.

This gets better usually quite quickly.co.uk Will the neck dissection be my only treatment or will I need any more? Once you have had your surgery the tissue they remove will go to the laboratory to be analyzed under the microscope by a Histopathologist (a doctor who examines tissue for diagnosis). You will have the opportunity to discuss the benefits of the treatment with your Consultant and if it is agreed that you need the treatment you will see a Oncologist who will give you the Leaflet Name: Leaflet Lead Name: Date Leaflet Approved Review Date Version No: Page 4 of 7 .co. He will be able to say whether there is any disease in the lymph nodes that will need further treatment.co. The skin under the chin can however remain swollen which can be permanent. this will usually be in the form of special xray treatment called Radiotherapy.uk We are Macmillan 0808 808 2020 www.uk Cancer backup 0800 800 1234 www. Once your Consultant has the report he will tell you the results and discuss with you whether you will need any further treatment. massage is good at softening the area and your consultant will advise you when you can start massage with a simple moisturising cream Damage to major blood vessels – In rare circumstances the major blood vessels in the neck (the carotid) can be damaged during surgery. There will be a scar which will fade and reduce in time.headandneckcancer. this is because tissue has been taken away. Although extremely rare this is serious and your Consultant will discuss the risks of this happening with you website www.cancerbackup. usually worse first thing in the morning.• • Cosmetic change – After neck surgery it can sometimes be noticeable that the operated side of the neck is flatter/slimmer compared with the opposite unoperated side. Immediately after surgery the face can be a little swollen.macmillan.

the benefits and any side effects with you. write them down so you can ask the doctor things that concern you. It is important that when you attend for any appointments that if you have any questions. It may also be useful to bring a family member or friend with you as they may remember things you have forgotten. Leaflet Name: Leaflet Lead Name: Date Leaflet Approved Review Date Version No: Page 5 of 7 .treatment and he will discuss the treatment plan.

on audio tape or disk and in other languages on request. Haddii aad jeclaan laheyd buug-yarahan oo af-Soomaali ku qoran la soo xiriir xarruunta bukaan ballaminta ama wax weydii xubin shaqaalaha ka tirsan. Please contact the Patient Advice and Liaison Service [PALS] on: Telephone 0151 529 3287 Textphone 0151 529 2523 Fax 0151 529 2019 [for the hearing impaired] Si vous voulez cette brochure en français. Braille. Leaflet Name: Leaflet Lead Name: Date Leaflet Approved Review Date Version No: Page 6 of 7 . contactez le bureau des rendez-vous ou demandez à un membre du personnel.If you require a special edition of this leaflet This leaflet is available in large print.

ac efallai mewn ieithoedd eraill ar gai Cysylltwch â chanolfan apwyntiadau cleifion i ofy am gopi. mewn pri bras. Mae’r daflen hon ar gael (ar gais).Si desea recibir este folleto en español. ar dâp sain neu ar ddisg. sírvase contactar al Centro de Citas para Pacientes o solicitario al personal. Leaflet Name: Leaflet Lead Name: Date Leaflet Approved Review Date Version No: Page 7 of 7 .

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