Surgery to remove the lymph nodes in your neck

Lymph nodes are small bean shaped glands found throughout the body, including the head and neck area. They are often the first place cancer cells spread to when they break away from a tumour.

Surgery to remove the lymph nodes in the neck is called a neck dissection. Surgeons don't routinely do a neck dissection on everyone because it can have long term side effects. They have to consider carefully who will benefit from it. 

You may have a neck dissection if your:

• type of salivary gland cancer has a high risk of lymph node spread
• lymph nodes are swollen
• scans show that the lymph nodes might have cancer cells in them

There are different types of neck dissection:  

• selective neck dissection
• modified radical neck dissection
• radical neck dissection

Partial or selective neck dissection

Your surgeon removes lymph nodes from some areas of your neck. It is usually the areas closest to the cancer. 

Modified radical neck dissection

There are 3 types of modified radical neck dissection.

With one type your surgeon removes most of the lymph nodes between your jawbone and collarbone on one side of your neck.

With the other 2 types your surgeon also needs to remove one or more of the following structures:

• a muscle on the side of your neck called the sternocleidomastoid muscle
• a nerve called the accessory nerve
• a vein called the internal jugular vein

You might have a modified radical neck dissection if the cancer is affecting more than one of the lymph nodes on your neck.

Radical neck dissection

You have nearly all the nodes on one side of your neck removed. Your surgeon will also remove:

• the sternocleidomastoid muscle
• a nerve called the accessory nerve
• the internal jugular vein

You might have a radical neck dissection if the cancer has spread to other nearby structures.

Side effects of neck dissection

The side effects depend on which structures have been removed or disturbed during surgery.

Shoulder stiffness and arm weakness

The accessory nerve controls shoulder movement. So if you have this removed, your shoulder will be stiffer and more difficult to move. If you have a partial or modified neck dissection, the weakness in your arm usually lasts only a few months. But if you have your accessory nerve removed, the damage is permanent.

Your doctor will refer you to a physiotherapist. They will show you some exercises to help improve the movement in your neck and shoulder. It is important that you do them.

Some people have problems with pain and movement a year after surgery. In this situation, your doctor may suggest a reconstruction of some of the muscles. But this isn't suitable for everyone.

Pain

You may also have some pain. Taking painkillers can help. Physiotherapy exercises can also reduce pain. Your doctor can refer you to a pain clinic if the pain continues or is not controlled with painkillers.

A thinner, shrunken and stiff neck

Your neck will look thinner and shrunken if you have had the sternocleidomastoid muscle removed.

Your neck might be stiff after the operation and you might need physiotherapy.

Swelling (lymphoedema)

After surgery to remove some or all of the lymph nodes in your neck, the area can be swollen. This can be due to general swelling around the surgical wound. This usually goes down within a couple of weeks. But it can also be a sign of lymphoedema, this swelling doesn’t go away.

Lymphoedema means a build up of lymph fluid that causes swelling. It can develop because surgery interferes with the normal flow of lymph in the lymphatics.

Lymphoedema in the head or neck can also cause symptoms inside your mouth and throat. This may include swelling of your tongue and other parts of your mouth.

Tell your doctor or nurse straight away if you have:

• any swelling or a feeling of fullness or pressure
• find it difficult to swallow
• have changes in your voice

They will refer you to a lymphoedema specialist if they think you might have lymphoedema. It’s important to start treatment early to stop the swelling from getting worse.

Chyle leak

Chyle is tissue fluid (lymph) that contains fat after it has been absorbed from the small bowel (intestine). It gets transported through the lymphatic channels to the bloodstream.

Sometimes one of these channels, called the thoracic duct, leaks after the operation. When this happens, lymph fluid or chyle can collect under the skin.

You may need to stay longer in hospital and go back to the operating theatre to repair the leak.

Blood clot

Sometimes the tubes of the drain that the surgeon puts in during surgery can become blocked. This can cause blood to collect under the skin and form a clot (haematoma). If this happens, you might need to go back to the operating theatre to have the clot removed and the drain replaced.

Other possible effects

You might have other effects due to damage to some of the nerves that supply the head and neck area.

They include:

• numbness of the skin and the ear on the same side as the operation
• loss of movement in the lower lip
• loss of feeling or movement on one side of the tongue

Exercises for lymphoedema

Using your head, neck and shoulder muscles may help to reduce swelling. Your physiotherapist or specialist nurse will usually go through these exercises with you. 

These exercises shouldn't be painful. You might have a feeling of stretching as you do them, this is normal. Stop doing the exercises if you have any pain and, if doesn't get better contact your doctor.

Do the exercises slowly and gently, don't rush them. You can rest between exercises. It might help to do them in front of the mirror so you can check that your shoulders are back and relaxed.