Head and neck cancer, like all cancers, has the potential to spread to additional places in the body. Head and neck cancers, due to their location, typically tend to spread (metastasize) first to the lymph nodes of the neck. When the tumor does spread to lymph nodes of the neck a neck dissection may be indicated. Neck dissection refers to any operation in which multiple groups of lymph nodes are removed as in continuity. There are many names that have been used to describe neck dissection (eg radical neck dissection, selective or modified radical), but all of these are ways of describing which lymph node groups are removed and if any other structures in the neck have to be removed as well to remove all of the tumor. The trend in more recent years is to remove as many lymph node groups as possible with making the maximal effort to save as many structures in the neck as possible.
A neck dissection may be performed alone or in combination with removal of the primary tumor or after completion of chemotherapy and radiation treatment of the primary tumor. After this operation is performed, usually the patient will stay in the hospital anywhere from 1 to 4 days, occasionally longer if the operation includes removal of a head and neck tumor as well. Patients will usually have drains that may come out in the hospital, although often the patient is taught to take care of the drains and sent home. The incision for a neck dissection will typically appear large at first but over time tends to heal well and be difficult for the casual observer to see. After neck dissection, there is typically not a great deal of pain, in fact the majority of patients are numb in the area of the operation. This is because in order to remove the lymph nodes, many of the nerves responsible for this sensation need to be sacrificed. Over time some of the feeling will return but this may take several months. In addition, after many neck dissections, the shoulder will be initially a little weak because of dissection of a nerve which contributes to this movement (the spinal accessory nerve). A physicial therapist will teach you exercises to help make the function of these muscles return to more quickly. In addition many patients will have a slight droop of the corner of their mouth due to dissection around one of the nerves that helps move the face (the marginal mandibular nerve) this most often returns with time. Less common but reported complications of neck dissection include bleeding into the neck (hematoma), infection of the skin, leakage of lymph fluid (chyle leak), wound breakdown, damage to the carotid artery with possibility of stroke, damage to the nerves that move the arm or regulate the size of the pupil, and very rarely death. Although we council you about all of these possibilities, head and neck surgeons perform many of these operations, are experts at the anatomy, making the complication rate over all very low.
If you have further questions about neck dissections or if you or a loved one has head and neck cancer please feel free to give us a call.
|
|
