Neck Dissection

Neck Dissection Surgery

• A neck dissection surgery is usually performed to remove a malignant tumour
• A neck dissection involves removal of the lymph glands and tissues affected by the tumour
• The lymph nodes that are removed are sent for histopathology analysis to determine the tumour stage
• The surgery aims to preserve all vital structures where possible including blood vessels and nerves
• The blood vessels and nerves may provide the blood supply for free tissue transfer used to reconstruct the defect caused by tumour removal – the tissue used for reconstruction may consist of skin, fat, muscle and bone often transferred from the arm, back or leg

Common types of neck dissection surgery

Modified Radical Neck Dissection (MRND)

• Removal of all lymph node groups routinely removed with preservation of one or more of the accessory nerve, sternomastoid muscle and internal jugular vein

Selective Neck Dissection (SND)

• Cervical lymphadenectomy with preservation of one or more lymph node groups that are routinely removed in a MRND
• Thus for oral cavity cancers, SND (I-III) is commonly performed
• For oropharyngeal, hypopharyngeal and laryngeal cancers, SND (II-IV) is the procedure of choice

Central compartment neck dissection

• The most commonly involved central lymph nodes in thyroid carcinoma are the prelaryngeal (Delphian), pretracheal, and the right and left paratracheal nodal basins
• A central neck dissection includes comprehensive, removal of the prelaryngeal and pretracheal nodes and at least one paratracheal lymph node basin

After neck dissection surgery

Cleaning

• You may shower
• Do not direct the water spray directly at the incision unless the skin is fully healed
• Rinse soap off with clear water and pat dry with a clean towel

Activities

Surgery involves disrupting some of the muscles and nerves that help your shoulder move – because of this your shoulder may be weaker

• Avoid carrying heavy objects with the arm of the operated side
• When sitting support your elbow and forearm on pillows
• Perform your neck and shoulder exercises 10 times twice a day
• Do not use a heating pad

Infection

Watch for and report to your doctor:

• Increased redness, tenderness or swelling at the incision site
• Abnormal drainage from the incision
• Any temperature more than 38.5 degrees
• Problems breathing, talking or eating and drinking

Neck pain

• Use pain medication as prescribed
• Continue shoulder exercises as recommended by your physiotherapist

Neck dissection recovery

• Neck pain and stiffness is common following surgery
• The neck is composed of vertebrae, ligaments that supply stability to the spine, and muscles that provide support and allow motion
• The neck is very vulnerable because it is less protected than the rest of the spine, it supports the head, and it is very flexible
• During your surgery the neck is extended (bent backwards) for the duration of the procedure which may be for several hours
• This can cause muscle spasm which then leads to pain and tension in the neck
• People with pre-existing neck problems such as cervical spondylosis or a previous whiplash injury are more susceptible

Exercise after neck dissection

• You should increase and / or maintain your neck and shoulder motion and strength through an exercise program
• Exercising the neck muscles before and after your surgery significantly reduces the risk of muscle strain and subsequent neck strain
• You should perform the following exercises after surgery
• Exercises should be done until a gentle tension is felt – do not bounce or the muscle will tighten up more – it is important to return to the central position

Do these exercises sitting in a chair

• Bend your neck backward so that your nose points to the ceiling – lower and repeat
• Tilt your head bringing your left ear to your left shoulder – and then your right ear to your right shoulder – keep your shoulders down and repeat
• Turn your head so that you are looking over your shoulder – keep your shoulders facing to the front
• Shrug your shoulders up to your ears with a one kilogram weight – try to make your shoulders as level as possible – repeat
• Pinch your shoulders back bringing your shoulder blades close together – repeat

Do these exercises standing

Put both hands on a wall at shoulder height – start with your elbows bent – push away from the wall straightening your elbows and rounding your back – hold, count to 5, relax and repeat

While standing arm length away from a wall:

• Face the wall and slowly walk your hand up the wall as far as possible – lean into the arm  – hold, relax and repeat
• Turn your side to the wall, slowly walk you hand up the wall as far as possible – lean into the arm – hold, relax and repeat – do  this on each side
• Drape a towel over your door – hold on to both ends of the towel and use it as a pulley to increase the range of motion for your shoulders

Do this exercise lying on you back

• Hold a brookstick or walking stick with your hands about a shoulder’s width apart – lift the stick up towards the ceiling and then behind your neck

DO NOT carry heavy objects that pull down the arm on the side of your surgery
DO use your arm on the side of your surgery normally for everyday activities
Walk with your shoulders back, head up and your shoulders level