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Neck dissection

Neck dissection

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    Head and neck cancer can spread to your lymph nodes. Lymph nodes are small oval or round glands along your lymphatic system. In your neck, your lymph nodes are organized into levels (see Figure 1).

    Figure 1. Levels of lymph nodes

    Neck Dissection Pre-operative Considerations

    The nodal levels that are removed in a neck dissection depend on where the original tumor is and where potential areas for spread are based on anatomical studies.
    As with any surgery, there are both potential benefits and risks. The following information will help you understand the risks of surgery. As with any operation, there may be some unanticipated complications in addition to those listed here:

    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.

    Details of Neck Dissection Surgery:

    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.

    Neck Dissection Post-operative Recovery

    Arrange for someone to stay with you for the first 24 hours.
    Go to bed and rest, lying on your back, with your head elevated with 2-3 pillows. You should be lying at a 45 degree angle.
    You may be up and around and able to go to the bathroom. You will be able to eat a light meal with assistance.
    Take medication only as directed.
    Some swelling and bruising are a normal occurrence.
    Place ice packs to the surgical site for the first 48 hours (on for 20 minutes, then off for 20 minutes).
    Keep the incisions moist with petroleum-based ointment. Cover any draining area with bandages. If they loosen, secure them with more tape. You may have a drain in place, which will be removed with the first dressing change.

    You may be up and around as tolerated but expect to tire more quickly than usual.
    Keep activity and meals light, avoiding meals that require significant chewing.
    On the 3rd day, you can remove all bandages and gently shampoo your hair in the shower with baby shampoo. It is advised to let your hair air-dry, but you may use a cool setting if you need to use a hair dryer.

    You will come into the office for a post-operative check-up.
    No alcohol for the first 7 days after surgery, which can increase bruising and swelling.

    Your swelling and bruising will gradually fade over this time period, but it may persist for up to 3 weeks.

    1. Rest and good nutrition are important healing factors, especially during the first 6 weeks.
    2. Numbness, tingling, hardness, tightness, and bumpiness of the surgical area are common occurrences. If any of these things do occur, they will gradually subside over several months.

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