Neck dissection operation

You will have been given this information sheet having visited our Head and Neck or Thyroid Oncology Clinic, where we will have recommended a neck dissection operation as part of your treatment plan.

We recognise that you may have questions at this time. This information sheet will provide answers to some of the more common questions that are asked by our patients about this operation.

Although it will provide you with some of the information that applies to your individual care, it is important to remember that every case is different.

This information is therefore not exhaustive and does not constitute medical advice.

The Head and Neck Oncology team will discuss any treatment that you require, with you. If you have any further questions about your treatment, you should contact a member of the team via the contact numbers listed in the Cancer Directorate Head and Neck Service Patient Information (PIN4013 (opens in a new tab)).

Why do I need a neck dissection operation?

A neck dissection operation is recommended when a cancer has spread, or is at risk of spreading, into the lymph nodes of the neck.

The operation involves the removal of lymph nodes, on one, or both sides of your neck.

Please approach a member of the team if you are at all unsure why this operation has been recommended for you.

What are lymph nodes?

The lymph nodes in your neck form part of a network known as the lymphatic system. This system helps the body in its fight against infection and also with the drainage of lymph fluid between the cells of the body. All remaining lymph nodes in your body are able to continue these functions even when the lymph nodes in your neck have been surgically removed.

What will the surgery involve and how will it affect me?

You will need to have a general anaesthetic. The operation routinely takes 3 hours, or longer, if this operation is part of more extensive surgery. The surgeon will aim to remove either a selection, or all of the lymph nodes on the affected side of your neck.

In total, there are over 50 nodes on each of side of your neck. These nodes are positioned in several layers between your lower jaw and collar-bone.

The surgeon may also need to remove two other structures. The sterno-mastoid muscle and internal jugular vein. This may be necessary to ensure that all of the cancer is removed.

The surgeon will always make every effort to protect the nerves in the area, but one or more of these nerves may become damaged or need removing if it is close to the cancer.

The nerve most at risk is the accessory nerve. This nerve helps you to raise your arm into a high stretch, for example touching the back of your head, or reaching up to a cupboard. This movement can be significantly affected if the accessory nerve is damaged or removed. Loss of the accessory nerve can also lead to permanent shoulder drop and stiffness following surgery.

The nerves that provide sensation to the skin of your ear and neck will also be affected after surgery. This area will feel numb and although this can improve with time, any numbness experienced in the lower lobe of your ear and in the skin surrounding your scar is likely to be permanent.

There is a further small risk to other nerves during the operation. Damage to these nerves can affect movement of your vocal cord and movement and sensation of you lower lip and tongue. Taste and sensation within the mouth can also be affected.

How will I look after the surgery?

The side of your neck where surgery has been undertaken will look slimmer than the other side, particularly if muscle is removed. You will also have an incision line.

You may experience puffiness and swelling under your chin. This can occur following surgical removal of the lymph nodes and any subsequent treatment to this area, when drainage of the lymph fluid in this area can become reduced.

The swelling may fluctuate day to day in the early stages, but usually improves over three to six months. Some patients report that it is more noticeable in the mornings, with drainage improving over the course of the day when they are up and about.

The swelling can be more noticeable and permanent if you require surgery and/or radiotherapy on both sides of your neck. If this is the case, please approach a member of the support team who can provide you with further information and support.

What will happen before my operation?

You may be asked to attend a pre-admission clinic before your surgery. At this appointment you will undergo examination and investigations to prepare you for surgery.

Please bring any prescribed medications with you and inform the doctor of any drug allergies that you have at this time.

It is usual to be admitted to a pre-admission ward on the day of your operation. You will meet the surgeon and anaesthetist before the operation. Once in hospital, the nurses will be able to inform you of the approximate time of your surgery the following day. They will also remind you to starve for at least six hours beforehand.

** Please note that every effort will be made to ensure that your operation will proceed on the planned date. However, it may be necessary for you to contact the hospital before your admission, to ensure that a bed is available for you.

What will happen on the day of my operation?

On the morning of surgery you will need to prepare for surgery. You may be asked to take a bath/shower and to change into a theatre gown.

After being taken to the Operating Department Reception by a nurse from the ward, you will be moved to a smaller room where you will receive your anaesthetic. This usually involves a small injection to the back of the hand. The anaesthetic will work quickly, and you will be unaware of events until your operation is completed.

What happens after surgery?

Once you have left the operating room, the nurses in the recovery area will take care of you until you are fully awake following your anaesthetic.

During this time:

1. Your blood pressure and pulse will be monitored using a cuff that will be secured around your arm; this will tighten when readings are taken.
2. Your temperature will be recorded using a small blunt ear probe (this does not penetrate deeply)
3. You will receive oxygen therapy via a mask that will cover your nose and mouth. Your oxygen levels will be monitored using another plastic probe that will be clipped gently onto your finger.
4. The nurse will monitor any discomfort that you experience. It is important that you inform them if you are in pain as they can give you pain relief.

Once awake, you will be transferred back to the ward where these observations are likely to continue, but with less frequency, as you recover from your anaesthetic and surgery.

What tubes and attachments will I have?

The most common tubes and attachments include:

A drip (Intravenous infusion)

This is used to give fluids into your blood stream using a small tube that is inserted into a vein in your arm. It is normally painless. The infusion will be discontinued once you are fully awake and eating and drinking, usually within 24 hours after surgery.

Wound drains

It is likely that you will have wound drains in place following your operation.

These drains will reduce any swelling and helps the wound to heal quickly. The drains will be removed once the drainage is reduced. This can vary from

3-5 days following surgery.

The nurses will be able to remove both these attachments on the ward, with minimal discomfort.

Metal clips or stitches

Either of these can be used to close your wound. They can usually be removed.

7-10 days after your operation by your practice nurse or district nurse, unless you are informed otherwise. The ward nurses will explain how to arrange this. Some of our consultants use specialised glue to seal the outer skin.

How will I feel after surgery?

It is natural to feel anxious after surgery, in particular when moving your neck. Your surgeon will have placed some dissolving stitches inside your wound, in addition to those on the surface. This means that you can move freely, without worrying that your wound might ‘open’. You may find it more comfortable to wear loose fitting clothing around your neck area in the first two weeks following surgery.

It is common to experience stiffness and aching in your shoulder area for several months following surgery and sometimes longer. This is usually as a result of bruising or damage to the shoulder nerves as discussed earlier. Your specialist nurse can provide you with shoulder exercise information (see leaflet PIN0806 (opens in a new tab)) which can help to relieve this discomfort.

How soon will I be able to be ‘up and about’?

Although you are likely to feel sleepy and will want to rest on the day of your surgery, you will be encouraged to gently move about, at the earliest suitable time. The nurses will show you how to take care of your ‘drip’ and ‘drains’ when doing this.

Getting ‘up and about’ will reduce the very small risk of getting a blood clot in the leg (deep vein thrombosis), following surgery. Nursing staff will also provide you with support stockings to wear for the first two weeks following your surgery.

In addition, it can help to reduce the small risk of developing a chest infection following your surgery. This risk is higher if you smoke. The nurses will encourage you to sit in an upright position during the day, and encourage you to move about at regular intervals.

Please refer Leg and breathing exercises following Surgery leaflet (PIN0826 (opens in a new tab)) for a list of breathing and leg exercises that you can undertake, while you are in hospital.

When will I be discharged?

Discharge is usually 2-6 days after surgery.

When can I work again and get back to my usual activities?

It is advisable to avoid heavy movement for the first 4 weeks following surgery. This includes any work/exercise that involves lifting, dragging, pushing, digging, etc.

This may be further delayed if there is a need for additional treatment such as radiotherapy\chemotherapy.

Work or exercise that involves lighter activity can be recommenced after 2 weeks, depending on how you are feeling.

You may wish to discuss returning to work with your community doctor (GP), as temporarily reducing your hours when you first go back to work, can sometimes be helpful.

Sexual activity can be resumed when comfortable.

Where can I obtain a sick certificate?

It is advisable to inform the ward nurses at least one day before you are discharged if you will need a sick certificate. This certificate will cover you for the first two weeks following surgery. You will need to get all further certificates from your community doctor (GP).

What happens next?

We will arrange to see you in the head and neck oncology clinic approximately two to three weeks after you have been discharged. At this time the surgeon will want to check your wound and re-examine your neck area. The results of any tissue samples taken during surgery should also be available. We will discuss any further treatment and appointments with you, at this time.

Where can I get further support?

Feelings of anxiety, guilt, anger and fear of the unknown, are some of the more common emotions that people experience, having been told that they have cancer.

We understand that this can be a stressful time for both yourself and those close to you.

If you would like further information about the support services that are available to you, please speak to your specialist nurse.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.