Radical Neck Dissection

Radical neck dissection is an 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 proven to be malignant. Variations on

A specimen taken from radical neck surgery. (Custom Medical Stock Photo. Reproduced by permission.)

neck dissections exist depending on the extent of the cancer. A radical neck dissection removes the most tissue. It is done when the cancer has spread widely in the neck. A modified neck dissection removes less tissue, and a selective neck dissection even less.

Precautions

This operation should not be done 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 vertebrae of the spinal column) or the skull. In these cases, the surgery will not effectively contain the cancer.

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, about 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.

Radical neck dissections are done in a hospital under general anesthesia by a head and neck surgeon. An incision is made in the neck, and the skin is pulled back to reveal the muscles and lymph nodes. The surgeon is guided

A digitized illustration of the human head and chest showing nasal passages, sinuses, trachea, vascular nerves, as well as ribs and parts of the lungs. (Custom Medical Stock Photo. Reproduced by permission.)

in what to remove by tests done prior to surgery and by examination of the size and texture of the lymph nodes.

Preparation

Radical neck dissection is a major operation. Extensive tests are done before the operation to try to determine where and how far the cancer has spread. These may include lymph node biopsies, CT (computed tomography) scans, MRI scans, and barium swallows. In addition, standard preoperative blood and liver function tests are performed, and the patient will meet with an anesthesiologist before the operation. The patient should tell the anesthesiologist about all drug allergies and all medication (prescription, non-pre-scription, or herbal) that he or she is taking.

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 done 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, patients 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 the patient is likely to lose. As a result, it is common following radical neck dissection for a person to have stooped shoulders, limited ability to lift the arm, 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 the microscope.

Abnormal results

Abnormal lymph nodes may be enlarged and show malignant cells when examined under the microscope.