Neck dissection, or cervical lymphadenectomy, is a surgical procedure that removes lymph nodes from the neck. These nodes are part of the body’s lymphatic system, filtering fluid and trapping foreign particles, including cancer cells. The surgery is most frequently performed to treat or stage head and neck cancers where the disease may have spread to the lymph system. Understanding the implications of this procedure is important for patients navigating cancer treatment.
The Purpose of Removing Neck Lymph Nodes
The primary reason for removing neck lymph nodes is to manage the spread of cancer originating from the head and neck region. Cancer cells frequently travel through lymphatic channels to these nodes, establishing secondary tumors. Removing the nodes is a therapeutic measure that eliminates existing disease and helps prevent further metastatic spread.
The procedure also serves a staging function in oncology. Pathologists analyze the extracted lymph nodes to determine the extent of cancer involvement, known as the N-stage of the tumor. This analysis guides subsequent treatment decisions, such as the need for additional radiation therapy or chemotherapy. For some cancers, nodes are removed even if they do not appear cancerous, due to a high risk of microscopic disease.
Understanding Different Surgical Approaches
The surgical classification is determined by the extent of tissue removed, defining three main categories.
Selective Neck Dissection (SND)
This is the most conservative approach, removing only specific groups of lymph nodes most likely to contain cancer. It preserves most surrounding non-lymphatic structures, such as muscles, nerves, and major blood vessels, minimizing patient morbidity.
Modified Radical Neck Dissection (MRND)
This procedure is more extensive, removing nearly all lymph node levels. Surgeons attempt to spare one or more of the three major non-lymphatic structures: the spinal accessory nerve, the internal jugular vein, or the sternocleidomastoid muscle.
Radical Neck Dissection (RND)
This is the most comprehensive surgery, removing all lymph nodes on one side. It also removes the spinal accessory nerve, the internal jugular vein, and the sternocleidomastoid muscle. RND and MRND carry a higher potential for post-operative functional deficits due to the removal of these structures.
Immediate Post-Operative Changes
Immediately following the procedure, patients have a surgical incision and often temporary drainage tubes placed in the neck. These surgical drains prevent the accumulation of fluid, such as blood or lymph, under the skin flap. Drains remain in place for a few days until the fluid output decreases to an acceptable level.
Acute pain at the surgical site is managed with prescribed medications. Temporary swelling (edema) in the neck and face is common and usually subsides within four to five days post-surgery. Stiffness and reduced neck mobility are also initial complaints due to surgical trauma and wound healing.
Patients may experience temporary sensory changes, including numbness around the incision or weakness in the lower lip or shoulder. These effects are often due to nerve bruising or stretching during the operation and improve as initial swelling decreases and the nerves recover. The initial recovery phase focuses on wound care, fluid management, and gradually regaining gentle neck movement.
Long-Term Physical Impacts
The removal of lymph nodes and the proximity of the dissection can lead to chronic, long-lasting consequences.
Cervical Lymphedema
Chronic swelling, known as cervical lymphedema, is caused by the disruption of lymphatic vessels and nodes. This fluid buildup can manifest in the face, neck, and upper chest, causing a persistent feeling of tightness or fullness.
Spinal Accessory Nerve (Cranial Nerve XI)
Damage to this nerve, which controls the sternocleidomastoid and trapezius muscles, is a source of long-term disability following extensive dissections. Injury results in “shoulder syndrome,” characterized by a painful, drooping shoulder, weakness, and difficulty lifting the arm or performing overhead movements.
Hypoglossal Nerve (Cranial Nerve XII)
Injury to this nerve impairs tongue movement, leading to weakness or paralysis on one side. This can cause the tongue to deviate toward the injured side when protruded. Consequences include difficulty articulating speech (dysarthria) and problems manipulating food during chewing and swallowing.
Vagus Nerve (Cranial Nerve X)
The Vagus Nerve and its branches, particularly the recurrent laryngeal nerve, may also be affected. Injury can cause vocal fold paralysis, resulting in a hoarse or breathy voice. This compromises the protective functions of the voice box, leading to difficulty swallowing (dysphagia) and an increased risk of aspiration. Chronic sensory changes, such as persistent numbness or tingling in the neck, ear, and shoulder area, are also common due to injury to smaller sensory nerves.
Rehabilitation and Recovery Strategies
Long-term recovery requires proactive management through physical therapy (PT) and specialized care. PT is central to restoring mobility and strength, especially for shoulder function compromised by Spinal Accessory Nerve injury. Patients learn specific exercises to prevent stiffness, maintain range of motion, and strengthen compensating muscles.
Shoulder exercises begin with gentle movements and gradually progress to intensive strengthening to address droop and difficulty lifting the arm. Lymphedema management involves working with a certified therapist using techniques like Manual Lymphatic Drainage (MLD), a light massage that redirects fluid flow away from the swollen area.
Compression garments, such as specialized wraps, may be recommended to manage fluid buildup. Scar management, involving gentle massage with lotions once the incision is healed, helps keep the skin supple and reduces tightness. Long-term follow-up with the oncology team monitors for late-onset complications and adjusts rehabilitation strategies.