A cervical lymph node dissection, often called a neck dissection, is a surgical procedure to remove lymph nodes from the neck region. This operation is most frequently performed as part of a treatment plan for head and neck cancers, such as those originating in the mouth, throat, or thyroid gland. The lymphatic system acts as a filter for the body’s tissues, but cancer cells can travel through this network and become trapped in the nodes. Removing these nodes is necessary to manage the progression of the disease.
Why Neck Lymph Nodes Are Removed
Lymph nodes are small, bean-shaped glands containing immune cells that filter foreign substances, including cancer cells, from the lymph fluid. When cancer is present in the head or neck, these nodes are often the first place malignant cells spread, a process known as metastasis. Surgeons remove these nodes for two main purposes: staging the cancer and treating the disease.
Staging involves analyzing the removed nodes to determine the extent of the disease and plan further treatment. Therapeutic removal aims to eliminate known cancerous lymph nodes, preventing the cancer from spreading to other parts of the body. The amount of tissue removed depends on the cancer’s location and stage.
Immediate Post-Operative Recovery and Changes
Initial recovery from a neck dissection typically involves a hospital stay of two to five days, depending on the procedure’s complexity. Patients manage incisional pain with prescribed medications. Temporary stiffness in the neck is common, and movement is encouraged soon after surgery to help prevent complications.
Surgical drains, often called Jackson-Pratt (JP) drains, are temporarily placed under the skin to prevent fluid accumulation at the surgical site. They are removed once the fluid output decreases sufficiently. Immediate swelling is a normal response to the surgery and usually subsides within four to five days. This acute swelling is distinct from chronic lymphedema, which may develop later.
Long-Term Functional and Sensory Impacts
A neck dissection can result in long-term functional and sensory changes due to the proximity of lymph nodes to nerves and muscles. The most frequent consequence is injury to the Spinal Accessory Nerve (Cranial Nerve XI), which controls the trapezius and sternocleidomastoid muscles. Damage to this motor nerve can lead to “shoulder syndrome,” characterized by weakness, pain, and shoulder drooping on the operated side. Paralysis of the trapezius muscle causes difficulty raising the arm and limits the range of motion.
Other nerves may also be affected, often temporarily, such as the marginal mandibular nerve, which controls lower lip movement. The greater auricular nerve, which provides sensation to the ear and jaw skin, is often severed, resulting in permanent numbness or altered sensation in these areas. Physical therapy and rehabilitation are important for strengthening surrounding muscles to compensate for nerve impairment. Functional recovery from nerve damage can be a prolonged process, sometimes requiring 12 to 18 months for improvement.
Understanding Cervical Lymphedema
Cervical lymphedema is a chronic consequence of neck dissection resulting from the removal of lymph nodes and vessels, which impairs lymph fluid drainage. This condition manifests as chronic swelling of the neck, jaw, and sometimes the face or throat. The swelling often feels doughy or tight and may be most noticeable in the morning or after periods of inactivity.
Internal lymphedema, which affects the mucous membranes of the mouth and throat, can have serious implications for daily function. This internal swelling can cause a sensation of something caught in the throat, difficulty swallowing (dysphagia), voice changes, or breathing difficulties. Chronic fluid buildup can eventually cause the skin and underlying tissues to become thickened, firm, or stiff.
Management involves Complete Decongestive Therapy (CDT), which focuses on rerouting the trapped fluid. A specialized massage called Manual Lymphatic Drainage (MLD) uses gentle skin stretching to encourage fluid movement away from the swollen area. Compression garments or devices, often custom-fitted for the head and neck, are also used daily to apply gentle pressure and maintain fluid reduction. This condition requires ongoing self-management and specialized therapy.