Neck dissection

Bleeding: As with any surgery, bleeding is a risk. This is a major surgical procedure, and some bleeding will occur. If this bleeding is significant, blood transfusion may be necessary both for medical reasons and to maintain the perfusion to the tissues. Please let your doctor or nurse know if this is against your wishes. Because we do not want to increase the chance of heavy bleeding during the procedure, it is very important that you stop any medications that impair the ability of your blood to clot, including aspirin, ibuprofen, Aleve, Advil, Excedrin, and over the counter herbal medications. Please refer of our list of medications to discontinue prior to surgery.

Infection: Though infection is not common, it is a risk with any surgical procedure. Should infection occur, it may require prolonged treatment in or out of the hospital. Fortunately, this is not common. A wound infection occurs in less than 5% of cases and is treated with antibiotics and drainage, and is usually not a serious problem.

Anesthesia: There are risks associated with any type of anesthesia including but not limited to respiratory problems, drug reaction, heart attack, stroke, brain damage, or even death. Other risks and hazards that may result from the use of general anesthetics include but are not limited to minor discomfort due to injury to the vocal cords, teeth, or eyes. You can discuss these risks with your anesthesiologist prior to surgery.

Scar: Scar location and extent will vary depending on the procedure you are having. Initially, this will be swollen and red. As it heals, the swelling and redness will lessen. It is a good idea not to expose the scar to direct sunlight for the first 6 months after surgery to prevent the scar from hyperpigmenting (getting dark).

Numbness: A lack of sensation around the area of your incision is very common and last for several months. In rare instances, the numbness can be permanent.

Weakness: It is possible that the cranial nerves in the area of dissection may be damaged during the dissection. Specifically, the nerves that control lower lip movement (cranial nerve 7), shoulder shrug (cranial nerve 10), and tongue protrusion (cranial nerve 12) are at risk during this procedures. The risk of temporary weakness to one of these nerves is approximately 5%, but the risk of permanent weakness in one of these areas is less than 1% unless your physician specifically discusses with you the intentional removal of one of these nerves.

Seroma: This is a collection of normal body fluid in the neck after removal of the drain. This can be treated with observation, as the body will eventually resorb it, or repeated needle aspirations. The risk of leaving seroma is that it could become infected.

Chyle leak: the lymphatic drainage channels can be disrupted by this type of surgery, which results in a collection of milky fluid under the skin. If this were to occur, a pressure dressing is typically applied along with medication and a specific diet in order to minimize the flow of this fluid. If these measures are not successful, revision surgery may be required.

An incision is made in one of the natural creases in the neck on the side of the dissection.  The desired lymph nodes are then dissected out from the surrounding soft tissues and removed.  In addition to the lymph nodes, other structures in your neck may need to be removed, including:

• The muscle on the side of the neck that helps you turn your head. When this muscle is removed, there will be an indent on that side of your neck. You will still be able to move your neck without difficulty.
• The nerve that allows you to raise your arm higher than your shoulder. Your surgeon will try to save this nerve. If it must be removed, you will have trouble raising your arm above a 90-degree angle on the side that the nerve was removed.
• A vein that collects blood from your brain, face, and neck. Removing this vein on one side of your neck won’t cause any problems. Other veins in your neck will collect and circulate the blood on that side of your neck and face.
• A salivary gland in the upper part of your neck. Removing this gland won’t cause any damage to your salivary function.

Once your lymph nodes have been removed, your incision will be closed with staples or sutures (stitches). The type of incision line you have will depend on which lymph nodes and structures were removed.