Radical neck dissection





Definition

Radical neck dissection is a surgical operation used to remove cancerous tissue in the head and neck.


Purpose

The purpose of radical neck dissection is to remove lymph nodes and other structures in the head and neck that are likely or known to be malignant. Variations on neck dissections exist, depending on the extent of the cancer. A radical neck dissection removes the most tissue. It is performed when the cancer has spread widely in the neck. A modified neck dissection removes less tissue, and a selective neck dissection even less.


Demographics

Experts estimate that there are approximately 5,000–10,000 radical neck dissections in the United States each year. Men and women undergo radical neck dissections at about the same rate.


Description

Cancers of the head and neck (sometimes inaccurately called throat cancer) often spread to nearby tissues and into the lymph nodes. Removing these structures is one way of controlling the cancer.

Of the 600 lymph nodes in the body, approximately 200 are in the neck. Only a small number of these are removed during a neck dissection. In addition, other structures such as muscles, veins, and nerves may be removed during a radical neck dissection. These include the sternocleidomastoid muscle (one of the muscles that functions to flex the head), internal jugular (neck) vein, submandibular gland (one of the salivary glands), and the spinal accessory nerve (a nerve that helps control speech, swallowing, and certain movements of the head and neck). The goal is always to remove all the cancer, but to save as many components surrounding the nodes as possible.

An incision is made in the neck, and the skin is pulled back (retracted) to reveal the muscles and lymph nodes. The surgeon is guided in what to remove by tests performed prior to surgery and by examination of the size and texture of the lymph nodes.


Diagnosis/Preparation

This operation should not be performed if cancer has metastasized (spread) beyond the head and neck, or if the cancer has invaded the bones of the cervical vertebrae (the first seven bones of the spinal column) or the skull. In these cases, the surgery will not effectively contain the cancer.

Radical neck dissection is a major operation. Extensive tests are performed before the operation to try to determine where and how far the cancer has spread. These may include lymph node biopsies, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and barium swallows. In addition, standard preoperative blood and liver function tests are performed, and the candidate will meet with an anesthesiologist before the operation. The candidate should tell the anesthesiologist about all drug allergies and all medication (prescription, nonprescription, or herbal) that are presently being taken.

Aftercare

A person who has had a radical neck dissection will stay in the hospital several days after the operation, and sometimes longer if surgery to remove the primary tumor was performed at the same time. Drains are inserted under the skin to remove the fluid that accumulates in the neck area. Once the drains are removed and the incision appears to be healing well, people are usually discharged from the hospital, but will require follow-up doctor visits. Depending on how many structures are removed, a person who has had a radical neck dissection may require physical therapy to regain use of the arm and shoulder.


Risks

The greatest risk in a radical neck dissection is damage to the nerves, muscles, and veins in the neck. Nerve damage can result in numbness (either temporary or permanent) to different regions on the neck and loss of function (temporary or permanent) to parts of the neck, throat, and shoulder. The more extensive the neck dissection, the more function a person is likely to lose. As a result, it is common following radical neck dissection for people to have stooped shoulders, limited ability to lift one or both arms, and limited head and neck rotation and flexion due to the removal of nerves and muscles. Other risks are the same as for all major surgery: potential bleeding, infection, and allergic reaction to anesthesia.

Normal results

Normal lymph nodes are small and show no cancerous cells under a microscope. Abnormal lymph nodes may be enlarged and show malignant cells when examined under a microscope.


Morbidity and mortality rates

The mortality rate for radical neck dissection can be as high as 14%.

Morbidity rates are somewhat higher and are due to bleeding, post-surgery infection, and medicine errors.


Alternatives

Alternatives to radical neck dissection depend on the reason for the proposed surgery. Most alternatives are far less acceptable. Radiation and chemotherapy may be used instead of a radical neck dissection in the case of cancer. Alternatives for some surgical procedures may reduce scarring, but are not as effective in the removal of all pathological tissue. Chemotherapy and radiation or altered fractionated radiotherapy are reasonable alternatives.

See also Carotid endarterectomy ; Parathyroidectomy ; Thyroidectomy .


Resources

BOOKS

Bland, K. I., W. G. Cioffi, and M. G. Sarr. Practice of General Surgery. Philadelphia: Saunders, 2001.

Braunwald, E., D. L. Longo, and J. L. Jameson. Harrison's Principles of Internal Medicine, 15th Edition. New York: McGraw-Hill, 2001.

Goldman, L., and J. C. Bennett. Cecil Textbook of Medicine, 21st Edition. Philadelphia: Saunders, 1999.

Schwartz, S. I., J. E. Fischer, F. C. Spencer, G. T. Shires, and J. M. Daly. Principles of Surgery, 7th edition. New York: McGraw Hill, 1998.

Townsend, C., K. L. Mattox, R. D. Beauchamp, B. M. Evers, and D. C. Sabiston. Sabiston's Review of Surgery, 3rd Edition. Philadelphia: Saunders, 2001.

PERIODICALS

Agrama, M. T., D. Reiter, M. F. Cunnane, A. Topham, and W. M. Keane. "Nodal Yield in Neck Dissection and the Likelihood of Metastases." Otolaryngology Head and Neck Surgery 128, no.2 (2003): 185–190.

Cmejrek, R. C., J. M. Coticchia, and J. E. Arnold. "Presentation, Diagnosis, and Management of Deep-neck Abscesses in Infants." Archives of Otolaryngology Head and Neck Surgery 128, no.12 (2002): 1361–1364.

Ferlito, A., et al. "Is the Standard Radical Neck Dissection No Longer Standard?" Acta Otolaryngolica 122, no.7 (2002): 792–795.

Kamasaki, N., H. Ikeda, Z. L. Wang, Y. Narimatsu, and T. Inokuchi. "Bilateral Chylothorax Following Radical Neck Dissection." International Journal of Oral and Maxillofacial Surgery 32, no.1 (2003): 91–93.

Myers, E. N., and B. R. Gastman. "Neck Dissection: An Operation in Evolution: Hayes Martin Lecture." Archives of Otolaryngology Head And Neck Surgery 129, no.1 (2003): 14–25.

Ohshima, A., et al. "Is a Bilateral Modified Radical Neck Dissection Beneficial for Patients with Papillary Thyroid Cancer?" Surgery Today 32, no.12 (2002): 1027–1030.

Wang, L. F., W. R. Kuo, C. S. Lin, K. W. Lee, and K. J. Huang. "Space Infection of the Head and Neck." Kaohsiung Journal of Medical Sciences 18, no.8 (2002): 386–392.

ORGANIZATIONS

American College of Surgeons. 633 North St. Clair Street, Chicago, IL 60611-32311. (312) 202-5000, Fax: (312) 202-5001. E-mail: http://postmaster@facs.org. http://www.facs.org .

American Academy of Otolaryngology—Head and Neck Surgery. One Prince St., Alexandria, VA 22314-3357. (703) 836-4444. http://www.entnet.org/index2.cfm .

American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329. (800) 227-2345. http://www.cancer.org .

American Osteopathic College of Otolaryngology—Head and Neck Surgery. 405 W. Grand Avenue, Dayton, OH 45405. (937) 222-8820 or (800) 455-9404, Fax: (937) 222-8840. info@aocoohns.org

OTHER

Amersham Health. [cited April 7, 2003] <http://www.amershamhealth.com/medcyclopaedia/Volume%20VI%202/n ck%20dissection.asp> .

Baylor College of Medicine. [cited April 7, 2003] http://www.bcm.tmc.edu/oto/grand/120293.html .

Eastern Virginia Medical School. [cited April 7, 2003] http://www.voice-center.com .

Medical Algorithms Project. [cited April 7, 2003] http://www.medal.org/docs_ch37/doc_ch37.23.html .

ThyroidCancer.Net . [cited April 7, 2003] <http://www.thyroidcancer.net/topics/what+is+a+neck+dissection? MS_Session=4ebe4755df4793bda647c0bf21fd977f> .

University of Washington Department of Surgery. [cited April 7, 2003] http://depts.washington.edu/soar/abstract/ab16.htm .


L. Fleming Fallon, Jr. MD, DrPH

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



A radical neck dissection is usually performed by a surgeon with specialized training in otolaryngology, head and neck surgery. Occasionally, a general surgeon will perform a radical neck dissection. The procedure is performed in a hospital under general anesthesia.

QUESTIONS TO ASK THE DOCTOR



  • What tests will be performed to determine if the cancer has spread?
  • Which parts of the neck will be removed?
  • How will a radical neck dissection affect daily activities after recovery?
  • What is the likelihood that all of the cancer can be removed with a radical neck dissection?
  • Are the involved lymph nodes on one or both sides of the neck?
  • What will be the resulting appearance after surgery?
  • How will my speech and breathing be affected?
  • Is the surgeon board certified in otolaryngology head and neck surgery?
  • How many radical neck procedures has the surgeon performed?
  • What is the surgeon's complication rate?

User Contributions:

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Oct 20, 2010 @ 12:12 pm
after radical neck surgery i can't swallow and have a feeding tube.the cancer wrapped around the carodic artery so a few cells were left behind. the surgery was done in june 2010 and just recently have the horrible pain on that side of the head shooting up to the temple. any solutions or data on this?
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Nov 7, 2010 @ 1:13 pm
Thank you sir,for this paper but you have ensured some lacking such as definition, indication & complications and also about how to follow up.bye
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Dec 12, 2010 @ 6:18 pm
What would be the average expected length of time in surgery be for a Radical Neck Dissection both with and without a Total Laryngectomy?
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Jan 19, 2011 @ 11:11 am
hI THERE

I have read up on everything re radical neck node disection and I am very worried, the reason being in July 2010 my husban had a complete laryngectomy, in December there was some strange growth next to the stoma that actually looked like a cyst full of puss. We went to the docter to have it checked as the Prof. that did my op was on leave, the docter did a sonar , with results coming back it stated there might be a possibility of cancer that returned but this can only be done with a biopsy.
When the Prof returned went to see him did the usual check for any nodes in the neck by the touch pul feeling stuck a needle into this growing puss pulled it out and squirted it down the drain said it wasnt necessary to send away. Yet made appointment for 3 weeks later to be in for a radical neck disection. from what i read this is a major operation and can affect many other functions of the body. and it also states that extensive tests needs to performed before the operation. Why isnt the Prof telling my husband all these things as well as explaining to him that he might need physical therapy to regain use of arm or shoulder.
This can be detrimental to my husband as he is a engineer and physically heeds body parts to operate. As it looks to me the Prof just wants to get this over and done with never mind the after effects. PLEASE GIVE ME ADVISE MY HUSBAND IS SCHEDULED TO GO IN ON THE 30TH JAN.

KIND REGARDS
LINDA SKUPIEN
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Mar 12, 2011 @ 5:17 pm
After my radical neck surgery of 3 months ago I have a hard time swalowing and vry swollen under my chin and on the side of my cheeks. Under my chin the skin is as hard as a rock. Why is this?
nigel
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Mar 29, 2011 @ 5:05 am
I'm haveing this prosedure doe in a couple of weeks what to exspect
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Jul 7, 2011 @ 7:19 pm
My husband hasd a total laryngectomy with neck dissection of the nodes.
THe swelling went down about 4 weeks after the surgery but has come back since going through Chemo and Radiaition.

He wants to know how long it will take to go away?
What about the stiffness in his neck Will that get better?

Is there anything that can be done to speed the process up?
Sunnyleigh
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Jul 24, 2011 @ 6:18 pm
My husband had his surgery on the 14th of July. He still has his draintube and will see the doctor tomorrow. He has has so much fluid from the drain that it was leaking everywhere. This morning he got up too fast and fainted to the floor. I beleive it had something to do with some of his main arteries being removed. He has been fine so far and no more problems but this is a radical surgery. Like our doctor explained to us it will be the last he can do there are no more parts to take unless we want my husband to have no quality of life. He is on a liquid diet and wont know until tomorrow if he will ever be able to eat again throught he mouth. We keep on praying. This is his 2nd neck dissection.
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Oct 17, 2011 @ 1:13 pm
Hi,
My father had a supraglotic laryngectomy and bilateral neck dissection, he can eat pretty good but is complaining of a hardening and stiffness of the neck! He feels like someone is squeezing
his neck and is very uncomfortable. What can he do?
thanks
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Nov 17, 2011 @ 12:12 pm
8 months ago my husbamd had radical neck dissection for larynex cancer ..
Took 80 lympnodes and 1/2 thyroid all came back clear of cancer now 8 months later he has trouble swallowing why ???
shereena
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Feb 1, 2012 @ 1:01 am
my husband 63 had total larynectomy just in may of this year and has been complaining of food feeling stuck in throat,started having yeast infection in mouth all of sudden got a lump that looked like bug bite next to stoma ent did biopsy and pet/cat he has cancer agin now around the cartoid artery and doc told him very low rate for cure.what the hell is what i say theses docs dont tell people that part before surgery,chemo and radiation,its so wrong.the docs.have to go by protocols that our government regulates this is not a free country.my heart is in my stomach and i dont want to tell our 10 year old son that daddys cancer came back.The doc.said if i do the total larynectomy they you dont have to worry about the cancer coming back.docs r full of it even the best docs.good luck to all my hearts breaking as we continue our journey with this crap.
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Feb 4, 2012 @ 6:18 pm
I had a radical neck dissection in April 2011. I have a dropped and rotated forward shoulder which is painful most of the time. I have had 10 weeks of physical therapy for my shoulder and neck with very little improvement. My neck feels like a tree truck and lately it feels like I’m being strangled, probably from the adhesions which I feel will only get worse. I am on two anti-depression drugs but still very depressed. With all this said ending my life seems like the best alternative. Do you feel any of these symptoms will improve with time? Is there something more I can be doing to improve my quality of life? Please let me know your thoughts.

Thank you,

Dale
Dave
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Feb 16, 2012 @ 9:09 am
Dale i have been thru that and ending your life is not an alternative.I am 3 years out of radition and Chemo and i have been thru many things..I still don't taste food like i should but i am back to work..Its TUFF and guys dont understand my slow pace,as i drive a gas tanker for a living.But although my neck is sometimes painful and my shoulder and arm hurt,life is even better.I went thru the depression and bad days dale,and nobody can understand what you feel..But believe me,I DO..You will improve it will take time and it will be faster than you think..Hang in there Dale i will be praying for you.Others did for me that i never even knew..Good Luck Dale your tuffer than you think you are and this is the tuffest thing you as a man will have to go thru for now. Good Luck Dale

An unknown friend
Dave
Del
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Aug 4, 2012 @ 11:11 am
My son will be having a Modified Radical Neck Dissection on August 14th. He had previous surgery to remove a portion of his tongue and all the lymph nodes on the right side in November. There was a tumor wrapped around a blood vessel and the node was positive for Squamous Cell. My son chose not to do the Radiation after surgery because of the effects to his mouth. Now on the opposite side of his neck, he has a large tumor in the lymph node and another one below the jaw that may be attached to the bone. I didn't feel the surgeon prepared him at all yesterday. What should he expect afterwards. Thanks.
William
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Sep 7, 2012 @ 1:13 pm
Hi I'm bill
I had my double neck dissection three weeks ago,as most I'm haven trouble eating cause of the swelling . I to are depressed , I tell my wife it's doom and gloom. It's horrible, my voise is shot . I just want the swelling to go down and the flem to slow down . I pray to all going threw this ! Cause as for me my doc said that I don't need any more treatments and I'm cancer free, I was treated at Sloans in n.y. Great hospital . I had squamous in the upper voise box and had it removed by lazer . Then my dissection that I wish I never had. This is like a living hell and I pray for Any person going threw this hell .
Karen
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Mar 30, 2013 @ 11:11 am
My Father had this surgery about a month ago. They removed his lymph nodes & took muscle from his pecks to fill the hole created in his neck. He had radiation treatment & was burned pretty badly on his chest from side to side. He is in a lot of pain,and coughs up blood & tissue. His taste buds are gone. He cannot swallow & goes in several times a week for protein iv's. He does not have a feeding tube. Twice a day my mother blends scrambled eggs & protein powder into liquid form & he makes her leave the room while he pours this down his throat. He was told that 6 weeks after surgery his tongue may turn black and if so he will never eat again. My Father is a big man, and I have seen him take pain that would make the average person crumble in minutes. This surgery & procedures are breaking his spirit & I am not sure how much more he can take before giving up & choosing death as an alternative vs another round of radiation or chemo. Other than a back injury from twenty years ago he was in better than normal physical condition before the surgery. I need to know if there is hope for him to have any part of a normal life after this? Do things get better? If so, when? If he ends up with a feeding tube, will this make him bed ridden for the rest of his life? Is there a chance that he will be able to swallow again? Will his taste buds come back? He can whisper but has almost no voice. Will he get his voice back?
Robert
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Jul 14, 2013 @ 9:09 am
I had radical neck dissection surgery 3 weeks ago. If I relax I am fairly pain free. But normal moving about and I have very sharp pain under my jaw line toward the chin and down the incision line to my collar bone. Swallowing is painful all the time - sharp pain each time I swallow. This seems to be getting worse with time rather than better. I am off pain meds as these don't help this pain at all. I hope this will turn around and get better. This surgery is following a parotidectomy and the parotid removal surgery was a piece of cake to recover from. Just some numbness of my ear but pain wasn't an issue.
Not complaining. Cancer is worse. But I wondered if PT would help this or does it take 6 months to a year to get past the worst of the pain? I am using the pain as a zen point. You know something singular that pulls your attention to a single point in order to enter zen. It works and the pain goes away until I start moving again and swallowing. But it does give some periods of relief throughout the day.
I can deal with this but do want to return to some semblance of normal at some point.
maria
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Sep 28, 2013 @ 12:12 pm
My husband had neck dssection in April this year to remove tumor & lymph nodes. I'm assuming it was radical as nerves, muscle vein etc removed. He was in hospital for a couple of weeks and after an infection was readmitted. He had 7 weeks of radio therapy. He lost so much weight he was admitted back into hospital for the last week of radiation. He had an NG feeding tube and contractd another infection. He is home now but cant eat anything but blended food/soup etc and vomits often after eating.He wakes up every day with his ear stuck to the pillow, he suffers constant pain in head, jaw , neck and shoulder. He also suffers with nausea and dizziness and his ear bleeds from radiation burn. As you can imagine, we are both unhappy with the negative affects from his treatment but he is alive and that fact makes me grateful and so very happy. I hope the treatment has fully removed the cancer and he will recover, even though the its very slow. I wish you all the best.
Maria
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Oct 13, 2013 @ 6:06 am
My husband has been re-admitted to hospital as he is still losing weight. Dr was unable to insert NG as it would not go past his throat.We have been told he has a stricture and they have taken biopsies. Also has another infection in his neck. I am really frightened now. Has anyone had this added complication? If yes please advise.
Gina
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Oct 16, 2013 @ 8:20 pm
I am going to have a thyroidectomy with radical dissection. I have looked all over the internet for photos of the after surgery look and all I can find are the ones that just had the thyroidectomy. Can you provide any photos or descriptions for me? Am curious about permanent scars. Also, should I discuss using radiation and chemotherapy vs. the radical dissection? Which one has the best statics? What is the length of recovery time with the dissection?
Thank you so much with any assistance you can provide.
bob
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Jun 19, 2014 @ 3:15 pm
I had a small cyst in my neck removed last year and found out there was cancer in it so I had my tonsil removed, did neck radiation-no chemo-I refused and they said I could get away without the chemo because it was isolated in my neck. Now they tell me that I have 2 more spots with cancer in my neck. I am 2 weeks away from a radical neck dissection. I am scared to be honest because the only reason I agreed with the radiation was that they had such high expectations of success. Even if they succeed in removing the cancer(and that is a big IF ) what quality of life will I have. All I am hearing here is a lot of pain and some permanent damage. I still work and have to be out and about. Can anyone tell me or where can I find pictures of what my face and neck will look like after this. Thanks I am seriously thinking of taking my chances with my new found natural cancer diet. This surgery sounds very bad.. The radiation was bad-I handled it very well. but this is sounds bad.

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