What Is Neck Dissection? Types, Procedure, Recovery and Side Effects

Neck dissection is a surgery to remove lymph nodes and the tissue around them from one or both sides of the neck. Surgeons use it to treat or check for head and neck cancer that has spread from the mouth, throat, voice box, thyroid or skin of the head and neck. The type of neck dissection depends on the cancer site, the stage and which lymph node levels are at risk.

The word dissection can sound alarming, and the operation is a big one. It helps to know what is removed, why and how people recover. This guide explains the levels of the neck, the types of neck dissection, how the surgery is done, what recovery looks like and which side effects to expect.

What Is Neck Dissection Surgery?

During a neck dissection, the surgeon removes lymph nodes from selected areas of the neck so they can be tested for cancer.

In a neck dissection, the surgeon removes the lymph nodes in selected areas of the neck. The neck has hundreds of small lymph nodes. These are part of the body’s immune system. They also act as filters. Cancer cells that leave a tumour often travel through lymph channels and get caught in these nodes first.

After the surgery, the nodes are sent to the pathology lab. The report shows whether cancer cells are present, how many nodes are involved and whether the cancer has grown outside the node. This information helps decide whether further treatment such as radiotherapy is needed.

Why Is Neck Dissection Done?

Neck dissection is done to remove cancer that has spread to the lymph nodes in the neck. It is also done as a precaution when the cancer is likely to have spread there but cannot yet be seen or felt. This lowers the chance of the cancer growing in the neck later and shows the surgeon how far the disease has reached.

There are two main reasons.

The first is when cancer has already spread to the neck nodes. Removing them is part of treatment. This is called a therapeutic neck dissection.

The second is when the nodes feel normal but the chance of hidden spread is high. This is common in oral cancer. The surgeon removes the nodes at risk as a precaution. This is called an elective neck dissection. A large trial of people with early oral cancer found that elective neck dissection gave better survival than waiting and operating only if nodes appeared later (D’Cruz et al., 2015).

Not everyone with cancer needs a neck dissection. The decision depends on the site and size of the tumour, scans and your overall health.

Neck Dissection Levels

Surgeons divide the lymph nodes of the neck into levels. The numbering helps them describe exactly which areas are removed (Robbins et al., 2008).

Cancers in different places spread to different levels first. Oral cancers most often spread to levels I, II and III. Thyroid cancers more often involve level VI.

Types of Neck Dissection

The neck dissection types are named by what is removed and what is left in place. Three structures are important. The large neck muscle called the sternocleidomastoid, the internal jugular vein and the spinal accessory nerve, which controls shoulder movement (Robbins et al., 2002).

Radical neck dissection

This is the most extensive type. The surgeon removes the lymph nodes at levels I to V along with the muscle, the vein and the spinal accessory nerve. It is used when cancer has spread widely in the neck or has grown into these structures. Because the nerve is removed, shoulder weakness is likely. This is why surgeons now use it only when it is truly needed.

Modified radical neck dissection

Here the same lymph node levels I to V are removed. The difference is that the surgeon saves one or more of the muscle, the vein and the nerve. In type I the nerve is kept. In type II the nerve and the muscle are kept. In type III all three are kept. Saving the nerve helps protect shoulder movement. This type is chosen when the nodes are involved but the cancer has not grown into these structures.

Selective neck dissection

In a selective neck dissection only the levels most likely to hold cancer are removed. The muscle, vein and nerve are all left in place. Because less tissue is removed, recovery is usually easier and shoulder problems are less common.

The supraomohyoid neck dissection is the best known type. It removes levels I, II and III. It is named after a small muscle in the neck, the omohyoid. It is often used for oral cancer when the neck nodes feel normal, since the first spread is usually to these levels. Other selective types include the lateral neck dissection, which removes levels II to IV, and the central neck dissection, which removes level VI.

Extended radical neck dissection

Sometimes extra nodes or structures need to be removed as well. These can include other lymph node groups, a nerve or a muscle. This is uncommon and is done only when the cancer has spread beyond the usual areas.

How Is Neck Dissection Surgery Done?

Neck dissection is done under general anaesthesia, so you are asleep during the operation. It is often performed together with surgery to remove the main tumour. The whole operation can take several hours.

The surgeon makes a cut in a natural skin crease of the neck. The skin is lifted to expose the lymph nodes and the fatty tissue around them. The affected lymph nodes are removed level by level. The surgeon works carefully around the nerves, the large blood vessels and the muscles. Nerves that control the shoulder, the lower lip and the tongue are identified and protected where possible.

When the dissection is complete, the surgeon places one or two thin tubes called drains under the skin. They collect fluid that builds up after surgery. The skin is then closed with stitches or staples.

Neck Dissection Recovery

Recovery depends on the type of operation and whether the main tumour was also removed. The time frames below are general. Your surgeon will tell you what applies to you.

A physiotherapist usually teaches simple neck and shoulder exercises. They are started when the surgeon says it is safe. Studies in people treated for head and neck cancer suggest that regular exercise can reduce shoulder pain and stiffness after neck dissection (McNeely et al., 2008).

At home, keep the wound clean and dry as advised. Take your pain medicine as prescribed. Sleep with your head slightly raised if the swelling bothers you. Follow-up visits are important. The surgeon will check the wound and discuss the pathology report. If radiotherapy is advised, it usually starts after the wound has healed.

Neck Dissection Side Effects

Every operation has risks. Some neck dissection side effects are temporary. Others can last longer. The risks are generally lower with selective types than with radical ones.

Most of these problems are treated with simple measures. Physiotherapy helps shoulder and neck movement. Swelling can be eased with massage and skin care taught by a therapist. A chyle leak or a fluid collection may need extra treatment.

Permanent numbness over part of the neck or ear is common. It is usually not painful. Many people get used to it over time.

When to Get Medical Advice After Neck Dissection

Some discomfort after surgery is expected. A few signs need prompt attention.

Dr. Amit Chakraborty, Head & Neck Cancer Specialist (MBBS, MS, MCh Surgical Oncology, Registered Medical Practitioner, 2008113798), explains that these signs often mean fluid, infection or bleeding that is best dealt with early. Being aware of them helps patients and families seek help in time.

Questions You Can Ask Your Surgeon

Before surgery, it can help to write down your questions. You could ask which type of neck dissection is planned and why. It is also reasonable to ask which lymph node levels will be removed and which nerves will be protected. You could ask what the recovery will involve and how long the hospital stay is likely to be. It is fair to ask about the risks that apply to you and what support is available afterwards. If you are unsure about any recommendation, you can ask for a second opinion.

This article is for general health education and is not a substitute for personal medical advice. Please speak to your treating doctor about your own diagnosis and treatment plan.

Frequently Asked Questions

What is neck dissection?

Neck dissection is a surgery to remove lymph nodes and surrounding tissue from the neck. It is mainly used for cancers of the head and neck that have spread or may spread to the lymph nodes.

What are the types of neck dissection?

The main types are radical, modified radical, selective and extended radical neck dissection. They differ in the number of lymph node levels removed and the structures that are kept.

What is radical neck dissection?

It removes the lymph nodes at levels I to V along with the large neck muscle, the internal jugular vein and the spinal accessory nerve. It is used when cancer has spread widely in the neck.

What is modified radical neck dissection?

It removes the same lymph node levels as a radical neck dissection but saves one or more of the muscle, the vein and the nerve. It is chosen when the cancer has not grown into these structures.

What is MRND surgery?

MRND means modified radical neck dissection. It removes lymph nodes from levels I to V but keeps one or more of the neck muscle, jugular vein and shoulder nerve.

What is selective neck dissection?

It removes only the lymph node levels that are most likely to hold cancer. The muscle, vein and nerve are left in place.

What is a supraomohyoid neck dissection?

It is a selective neck dissection that removes levels I, II and III. It is often used in oral cancer when the neck nodes feel normal.

What are the levels of neck dissection?

The neck lymph nodes are grouped into levels I to VII. Level I is under the chin and jaw. Levels II to IV run down the side of the neck. Level V is at the back, and level VI is at the front around the voice box and thyroid.

How long does neck dissection recovery take?

Most people stay in hospital for a few days. Daily activities often return over two to four weeks. Stiffness and numbness may take months to improve.

What are the side effects of neck dissection?

Common effects include neck numbness, stiffness and swelling. Shoulder weakness, lower lip weakness, infection and fluid collection can also occur. Your surgeon will tell you which risks apply to you.

Is neck dissection a major surgery?

Yes. It is done under general anaesthesia and can take several hours. Most people recover well with proper wound care and exercises.

Will I have a scar after neck dissection?

Yes. The cut is placed in a natural skin crease where possible. The scar usually fades over time.

References

D’Cruz, A.K. et al. (2015) ‘Elective versus therapeutic neck dissection in node-negative oral cancer’, New England Journal of Medicine, 373(6), pp. 521–529.

McNeely, M.L. et al. (2008) ‘Effects of exercise on upper extremity pain and dysfunction in head and neck cancer survivors: a randomized controlled trial’, Cancer, 113(1), pp. 214–222.

Robbins, K.T. et al. (2002) ‘Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology–Head and Neck Surgery’, Archives of Otolaryngology–Head & Neck Surgery, 128(7), pp. 751–758.

Robbins, K.T. et al. (2008) ‘Consensus statement on the classification and terminology of neck dissection’, Archives of Otolaryngology–Head & Neck Surgery, 134(5), pp. 536–538.