Neck Dissection

• Neck dissection is a surgical procedure performed to remove cancerous lymph nodes from the neck.
• It is a common treatment for various head and neck cancers to control disease spread and improve prognosis.
• Different types of neck dissection exist, tailored to the extent and location of the cancer.
• The procedure aims to achieve local and regional control of cancer, reducing the risk of recurrence.
• Recovery involves managing pain, swelling, and potential temporary functional changes, often requiring physical therapy.

What is Neck Dissection?

Neck Dissection refers to a surgical procedure performed to remove lymph nodes from the neck. This operation is primarily undertaken to treat various types of head and neck cancers, particularly when there is a risk of cancer spreading to the lymph nodes or when cancer has already metastasized there. The goal of what is neck dissection surgery is to remove cancerous tissue, prevent further spread, and accurately stage the disease. The extent of the dissection depends on the type and stage of cancer, as well as the specific lymph node regions involved. According to the American Cancer Society, head and neck cancers account for approximately 4% of all cancers in the United States, often requiring such surgical interventions for effective management.

Types of Neck Dissection and Surgical Procedure

The approach to neck dissection is highly individualized, based on the specific cancer type, location, and spread. A comprehensive neck dissection procedure explanation involves understanding the different classifications of the surgery, which are determined by the extent of tissue removal.

There are several types of neck dissection surgery, each varying in the amount of tissue removed:

• Radical Neck Dissection (RND): This is the most extensive type, involving the removal of all lymph nodes from levels I to V, along with the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve. It is typically reserved for advanced cancers with significant nodal involvement.
• Modified Radical Neck Dissection (MRND): This procedure removes the same lymph node levels as RND but spares one or more of the non-lymphatic structures (sternocleidomastoid muscle, internal jugular vein, or spinal accessory nerve) to preserve function and reduce morbidity.
• Selective Neck Dissection (SND): This is the least extensive type, targeting only specific groups of lymph nodes that are most likely to be affected by a particular primary tumor. For example, a supraomohyoid neck dissection targets levels I-III for oral cavity cancers.

The surgical procedure typically involves an incision in the neck, through which the surgeon carefully identifies and removes the targeted lymph nodes and surrounding tissues. Drains are often placed to remove excess fluid, and the incision is then closed. The removed tissue is sent for pathological examination to determine the presence and extent of cancer.

Recovery and Potential Outcomes After Neck Dissection

The neck dissection recovery time varies significantly among individuals, depending on the extent of the surgery, the patient’s overall health, and any additional treatments received. Immediately after surgery, patients typically experience pain, swelling, and stiffness in the neck and shoulder area. Pain management is crucial during this period.

Hospital stays can range from a few days to a week. Post-operative care often includes drain management, wound care, and physical therapy to restore range of motion and strength in the neck and shoulder. Potential outcomes and side effects can include:

• Numbness or altered sensation in the neck and ear.
• Shoulder weakness or stiffness, especially if the spinal accessory nerve was affected.
• Swelling (lymphedema) in the neck or face.
• Temporary or permanent voice changes.
• Difficulty swallowing.

Most patients gradually regain strength and function over several weeks to months. Long-term follow-up is essential to monitor for recurrence and manage any persistent side effects. The primary goal of the surgery is to achieve local and regional control of the cancer, improving the patient’s prognosis and quality of life.