A neck dissection is an operation to remove lymph nodes from the neck on one or both sides. The lymph nodes need to be removed if they contain melanoma.
Neck lymph nodes
What are lymph nodes?
Lymph nodes are part of your immune system and are present throughout your body. Their job is to filter the liquid, which naturally leaks out of blood vessels. This liquid (the lymph) travels to the nodes, which contain lots of white blood cells designed to trap and fight germs, which can cause infection. You may have felt swollen lymph nodes in your neck when you have had an infection such as a simple cold. As well as trapping germs, the lymph nodes can also trap cancer cells that have migrated from a primary tumour.
Have I got cancer in my lymph nodes?
It is often not possible to tell this until after your operation when the nodes removed from the neck are carefully looked at under a microscope. Your doctor will have already felt your neck to see if there are any lumps and you will have had a special scan (CT or MRI) to look more closely at the nodes or had a sentinel node biopsy. Nodes can feel big if there is infection in the area, so if you can feel a lump in your neck it does not necessarily mean that the cancer has spread.
If there is only a small amount of cancer cells present in the nodes then the neck can feel normal and look normal on scan. This is often why we do not know if the cancer has spread to the neck until the nodes have been looked at under a microscope.
Will I be able to fight infections once my lymph nodes have been removed?
Yes. There are hundreds of lymph nodes throughout your body which will still be there to fight infection.
What does the surgery involve?
A large incision is made to gain access to the lymph nodes in the neck. Once the lymph nodes have been removed the flap of skin is replaced with stitches or clips.
What can I expect after the operation?
At the end of the operation a number of tubes are placed through the skin into the wound to drain any blood which may collect. These usually stay in place for a few days before being removed.
Some discomfort is to be expected and is usually worse for the first few days, although it may take a couple of weeks to completely disappear.
It is necessary to make sure that the incisions heal without any infection and so you will be given antibiotics through a vein in your arm whilst you are in hospital. You will also be given regular painkillers.
The skin stitches or clips will be removed around a week following surgery.
The skin of your neck will feel numb for several months after surgery as a result of bruising to the nerves.
What are the possible side effects?
There are potential complications with any operation. Fortunately with this type of surgery complications are rare and may not happen to you. However it is important that you are aware of them and have the opportunity to discuss them with your surgeon. Most of the problems associated with neck dissection are the result of damage to one of two nerves:
- Accessory nerve – this is a nerve which runs from the top to the bottom of the neck and helps you to move your shoulder. The nerve has lots of lymph nodes lying very close to it and so can be temporarily damaged during a neck dissection. If the nerve is bruised it can stop working for several months. If this happens you may experience pain and some difficulty in moving your shoulders, which makes getting dressed less easy. Rarely the lymph nodes cannot be completely removed without cutting this nerve. Should this be the case then these shoulder problems will be permanent.
- Facial nerve – the branch of the facial nerve, which makes your lower lip move, can be bruised when the lymph nodes close to it are removed. If this happens then the lower lip doesn’t move properly and you may end up with a weakness, which results in a crooked smile. The majority of these get better on their own but can take several months to improve fully.
- Haematoma – This is the name given to a collection of blood that has formed a blood clot around the site of the operation. This may be treated in 1 of 2 ways.
- If small it may be left to be reabsorbed by your body’s normal defences.
- It may be necessary to return to the operating theatre to find the area it is bleeding from and to seal the area from further bleeding and to remove the clot of blood.
- Chyle Leak – Major Lymph channels are encountered at the lower aspect of the neck, especially on the left side. These are carefully tied off to prevent lymph drainage into the wound. Occasionally a lymphatic leak occurs despite these efforts. Food in the stomach can increase the amount of lymphatic flow. A diet change and a pressure dressing can usually control this problem, but return to the operating room may be required for repair.
Will I need to have further treatment after my neck dissection?
Hopefully not but this depends on what is found when the lymph nodes are looked at under a microscope. It takes a week or more to look at the lymph nodes properly so your doctors will not know until then whether further treatment is necessary. Any additional treatment usually involves radiotherapy or chemotherapy.