Definition A radical neck dissection is a procedure used to remove cancerous tumours from one side of the neck or upper airway. Almost all the lymph nodes and some of the muscles, tissues, veins, and nerves in this area are removed as well.
Who is a candidate for the procedure? A person who has a cancerous tumour in the lymph nodes in the neck and upper airway is a candidate for this procedure.
How is the procedure performed? The procedure is done under general anaesthesia. This means that the person will be put to sleep with medications. An incision, or cut, is made under the chin towards the ear. Another incision is made at the bottom of the neck. A third incision is made down the middle of the neck. These three cuts form the shape of a sideways "H." Other incisions may also be made so the surgeon has a full view of the structures inside the neck. The skin is then spread open and the tissues underneath the skin are pulled away from the skin. The surgeon then removes the lymph glands from the neck and oral cavity.
In addition to the lymph nodes, there are three main structures that are removed from the neck area. These are:
the internal jugular vein
the accessory nerve
the sternocleidomastoid muscle
Any other veins, nerves, or muscles that are involved with the cancer are also removed. If the cancer has spread, it may be necessary to remove sections of the jaw and tongue. At times, it is also necessary to perform a tracheostomy. A tracheostomy is a surgically created opening through the neck into the trachea, or windpipe. The incision is closed with sutures, staples, or skin clips.
What happens right after the procedure? Usually after a radical neck dissection, a person will be in the surgery recovery room for a few hours for close monitoring. Oxygen will be given through a facemask or nasal prongs. Analgesia will be given as needed. A person cannot eat or drink anything at first. Then later in the day, the person can start taking small sips of fluid. There may be a few tubes that are left near the incision to drain fluids and blood. These tubes will be removed once the draining stops.
For the next few days the person will be encouraged to do deep breathing. This helps to clear the lungs and prevent pneumonia. The day after surgery the person will be encouraged to get out of bed and walk around. This helps to lower the risk of blood clots.
If a tracheostomy was done, the person (and family members) will be given special training in caring for the tracheostomy site.
What happens later at home? The person will be in the hospital from 4 to 14 days. Activity at home will be based on how the person is recovering. Usually a small amount of activity is recommended on the first day or two after getting home. The person can increase the activity level if he or she feels ready. Sutures, staples, or clips are usually taken out 7 to 10 days after surgery. A person is advised not to drive or participate in strenuous activity for several weeks.
What are the potential complications after the procedure? After a radical neck dissection a person may have bleeding at the surgery site, infection, pain, and scarring. There is also a chance for injury to the veins and nerves in the neck. This can cause bleeding or numbness. This procedure may also cause a deformity of the neck and face.
Author: Eileen McLaughlin, RN, BSN Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 25/05/2005 Contributors Potential conflict of interest information for reviewers available on request
