Neck Dissection

This form of surgery will be required in cases where the cancer of the head and neck have a chance to spread further into the body. This spread occurs through the lymph nodes which are small round or oval glands of the lymphatic system. For easier understanding these lymph nodes are divided into five sections within the neck (Roman numerals I,II,III,IV,V).
Based on the severity there are three kinds of neck dissection

• Radical Neck dissection
• Modified radical neck dissection
• Selective neck dissection

The goal of neck dissection is to remove all the lymph nodes within a predefined anatomic area. Many of the lymph nodes removed during surgery will not prove to have cancer in them.

A cancer may shed any number of metastases that lodge in lymph nodes, grow and spread. There are over 150 lymph nodes on each side of the neck. During an operation, a surgeon will not be able to tell if a lymph node is clean, or if it has cancer that will later grow into a visible neck lump. The lymph nodes must be processed and tested; this takes time. For that reason, it is recommended that the lymph nodes in a predefined region are removed, not just lymph nodes that are obviously enlarged with cancer.

In addition, different cancers spread differently. Skin cancers first spread to lymph nodes in different parts of the neck than thyroid cancers or oral or larynx cancers. Squamous cell carcinomas that start in the lining or mucosa of the mouth, throat or larynx have a tendency to spread to lymph nodes early; cancer cells can often be detected in lymph nodes in the neck when examined under the microscope, even in the absence of visible or palpable neck lumps.

Lymph node metastasis reduces the survival of patients with squamous cell carcinoma by half. The survival rate is less than 5% in patients who previously underwent surgery and have a recurrent metastasis in the neck. Therefore, the control of cancer that has spread to the neck is one of the most important aspects in the successful management of these particular cancers. The neck dissection is a standardized procedure that was developed to ensure the complete removal of cancer that has spread to the lymph nodes of the neck.

Neck dissections are subject to numerous potential operative complications that are common to all operative procedures, as well as complications specific to this procedure. Some of these are described below, but do not include all potential complications associated with neck dissection. The risk of specific complications may be best determined for an individual by the nature and extent of their cancer, prior treatment and other circumstances.

• Bleeding-Patients may bleed after an operation. Bleeding under the skin after a neck dissection is rare. Sometimes an operative procedure to remove the blood is required. Rarely, a blood transfusion is also needed.
• Infection can occur after any surgical procedure including neck dissection (uncommon)
• Chyle leak, which results in fluid accumulation in the neck from disruption of the thoracic duct (this problem is more common after left sided neck dissections) (rare)
• Wound healing problems requiring additional surgery (rare)

• Incision-Most incisions heal well, but some individuals develop scars.
• Numbness of the skin along the incision as well as over the cheek, ear and neck can be anticipated which improves with time; some long-term numbness can be anticipated
• Neck stiffness or pain
• Long-term swelling in the neck or lymphedema
• Shoulder weakness (uncommon)
• Changes in speech and swallowing (rare)
• Some problems are attributable to nerve injury; more commonly, scarring under the skin from surgery and radiation contributes to disability. Some problems may be avoided with early and faithful adherence to a shoulder range of motion exercise program, lymphedema or speech therapy rehabilitation programs.

• Physiotherapy – to aid in mobility and movement of the neck
• Speech therapy – In cases of speech impediment speech therapy will help will be of great help.