Neck dissection is the surgical excision of lymph nodes and surrounding tissue from the neck to cure cancer. The extent of tissue removal is determined by many criteria, including the disease stage, which represents cancer's extent, and the type of cancer. Head and neck squamous cell carcinomas, skin cancers including melanoma, and thyroid tumors are the most commonly removed tumors from lymph nodes in the neck. In general, the objective of neck dissection is to remove all lymph nodes within a specific anatomic area. Numerous lymph nodes excised following surgery will be found to be cancer-free. Neck dissection surgery is classified into the following three distinct subtypes:
- Radical neck dissection: The entire side of the neck is dissected from the jawline to the collarbone. This area is devoid of muscle, nerve, salivary gland, and major blood vessels.
- Modified radical neck dissection: During this procedure, all lymph nodes are removed. Fewer neck tissues are removed compared with radical dissection. Additionally, this procedure may spare the neck nerves and the blood vessels or muscle in some cases.
- Selective neck dissection: If cancer has not progressed beyond the neck, fewer lymph nodes must be removed. The neck muscle, nerve, and blood vessels may also be preserved.
How is neck dissection Surgery performed?
Neck dissections are performed under general anaesthesia via an incision that runs vertically along a skin crease in the neck, extending vertically on the side of the neck. Incisions are typically designed to improve visualization and protection of critical neck structures, as well as for the safe removal of cancerous lymph nodes.
The dissection then proceeds to identify and remove the tissue containing the lymph nodes beneath the skin, underlying fat, and a thin layer of muscle (platysma). While removing the sternocleidomastoid muscle as a part of the operation, may result in minor neck flattening. This muscle rarely results in severe weakening.
Preparation For Neck Dissection
All patients should undergo a routine preoperative examination by a physician who specializes in anaesthesia. Preoperative medical clearance should be obtained for patients with cardiac issues or complex medical history. Any patient taking anticoagulation should have a well-defined protocol for perioperative anticoagulation care.
If there is a risk of substantial airway obstruction as a result of disease, anatomy, or past therapy (e.g. previous radiation or cervical spine surgery), awake fiberoptic intubation or awake tracheostomy can be used and coordinated with the anaesthesia team.
Before the surgery, all patients should get a comprehensive oncological examination. This should involve a biopsy to confirm the diagnosis of malignancy, head and neck imaging, and PET-CT or chest CT to assess for distant metastases.
Follow-up care is critical for treatment and patient safety. Follow-up care is required to rule out the possibility of recurrence or the formation of a second primary tumor. The patient's first appointment following surgery will be around one week after discharge from the hospital. Following surgery, a pathologist will examine the lymph nodes that were removed. The results of the test are typically available within one week. Depending on the results, the patient may require additional treatment. During the patient's first follow-up appointment following surgery, the healthcare provider will share the results with them.
Risks For Neck Dissection Surgery
Haemorrhage risk from major vessels, chyle fistula, pneumothorax, and nerve injury to several nerves are all possible intraoperative consequences (particularly CN VII, CN X-XII, sympathetic chain, the brachial plexus, phrenic nerve, and lingual nerve). The spinal accessory nerve is frequently injured during modified radical neck dissections, with a reported injury rate of 33% in a recent meta-analysis. Additionally, the marginal mandibular branch is frequently damaged, with rates ranging from 5% to 12%.
Complications following surgery are uncommon. Complications include wound dehiscence, percutaneous or pharyngocutaneous fistula, infection, hematoma, sialocele, and chyle fistula.
Recovery From Neck Dissection Surgery
It is natural for the patient to have less energy than usual following this operation. Each person's recovery time is unique. Daily activities should be increased, and activity intervals should be balanced with rest periods. Rest is critical for recuperation. Avoid all activities that could place strain on the incision until advised by a health care expert, including the following:
- Lifting objects weighing more than ten pounds (4.5 kilograms)
- Strenuous activities (such as jogging and tennis)
- Sexual behaviour
The healthcare practitioner may instruct patients to perform specific exercises daily and will provide written instructions during the first session following surgery.
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