Neck Dissection Your Operation Explained

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1 Neck Dissection Your Operation Explained Patient Information

2 Introduction This leaflet tells you about the procedure known as a neck dissection. It explains what is involved, and some of the common complications associated with this procedure that you need to be aware of. It is not meant to replace the discussion between you and your surgeon, but helps you to understand more about what is discussed. What is a neck dissection, and why do I need it? The neck contains lots of small structures called lymph nodes. These are often better known as glands and we have all been aware of them at some time in our lives, when they get enlarged and tender with colds and sore throats. Their main job is to help us deal with infections but they also become involved in the spread of some cancers, and may also become enlarged if this happens. A neck dissection is an operation designed to remove some of these lymph nodes either because we know or suspect that your cancer has passed into the lymph nodes and needs to be removed, or because there is a known risk that it may do so. All the tissues that are removed are examined in detail under the microscope to look for cancer cells by a specialist pathologist. There are different types of neck dissection, each used for different reasons. Your surgeon will discuss with you the details of the operation you are having. The operation is performed under a general anaesthetic and normally takes around a couple of hours if performed on its own. However, it is often performed as just one part of a bigger cancer operation. The most common incision or cut used is a curved one starting just below the chin and ending just below the ear. These incisions will be closed with stitches or metal staples and usually heal very well. Does removing these nodes leave me more prone to infection? No. There are thousands of lymph nodes all over the body, so losing those in the neck makes no difference at all. Apart from the nodes, are any other structures removed in the neck? This depends on the particular type of neck dissection performed and 1

3 you should ensure that you discuss this with your surgeon. With the most radical versions of the operation, a nerve called the spinal accessory nerve, that moves some of the shoulder muscles, is removed because it is surrounded by lymph nodes. This results in some stiffness of the shoulder and sometimes pain. The effects of this can be helped by physiotherapy after the operation and this will be arranged for you if required. You can also help to reduce this by performing the exercises you will be shown, on a long-term basis. Even if the nerve is preserved, it may sometimes be bruised by the surgery, so a complete lack of shoulder problems cannot be guaranteed, but in most cases, the effects, if any, will recover over a period of months although in other cases they can be permanent. Some of the more radical types of neck dissection also involve the removal of a muscle called the sternocleidomastoid muscle and the internal jugular vein. We can manage perfectly well without these. Removal of the muscle does cause some flattening of the neck afterwards but removing the vein on one side of the neck seems to make no noticeable difference. Are any other nerves affected by the operation? Yes. As with any incision, the cut that is made always severs lots of tiny nerve fibres in the skin. This tends to leave the skin above the cut feeling rather numb. Much of this recovers with time and most people do not notice it much at all. The nerve that supplies the front of the tongue (lingual nerve) may also be damaged. This is unusual but if it does occur it leaves the front of the tongue numb and with some disturbance of taste. Another small nerve that is vulnerable is the mandibular branch of the facial nerve, which lies just below the jaw bone and works the little muscles that act on the corner of the lower lip. This nerve may sometimes get damaged; leading to a slightly uneven smile. In most cases this recovers over time, but it may not recover fully. Deeper in the neck lies the hypoglossal nerve which may be damaged and may occasionally even need to be cut, but this very rarely happens. This nerve moves one half of the tongue (and a few other smaller muscles). In most cases it will recover, but if not, that side of the tongue will not move properly. If this happens you 2

4 may find it difficult to clear food from the side of the mouth and your speech may become slightly slurred. Your speech and language therapist will help if these problems occur. Can there be any other complications? One rare complication is called chyle leak (pronounced kile ). If this occurs then it appears some days after surgery. In this condition a natural tube which comes up from the abdomen and into the neck develops a leak, leading to loss of fluid from the neck drain or wound. It can normally be cured using a special diet and seldom needs any other intervention, but it usually keeps patients in hospital for longer. As with all surgery, complications can occur although these are uncommon. After any major operation there is a risk of: Chest infection. You can help by practising deep breathing exercises and following the instructions of the physiotherapist. If you smoke, it is a good idea to stop smoking as far ahead of the operation as possible as this will also reduce the risk of chest infection. Wound infection. In some cases antibiotics can be given through a drip to help reduce the risk of this happening. Thrombosis (also known as blood clot). This is due to changes in the circulation during and after surgery. A small dose of heparin (anti-clotting medication) may be injected daily until you go home. You can help by moving around as much as you are able and in particular regularly exercising your legs. You may also be fitted with some support stockings for the duration of your stay in hospital. Stopping smoking may also help reduce this risk. Pulmonary embolism. Rarely a blood clot from the leg can break off, travel through the heart and get stuck in the lungs. This can be very serious and, rarely, even fatal. Sometimes the drainage tubes, which are put in at the time of surgery, become blocked, causing blood to collect under the skin and form a clot (haematoma). If this happens it is usually 3

5 necessary to return to theatre to remove the clot and replace the drains. Most people will not experience any serious complications from their surgery. However, risks do increase with age and for those who already have heart, chest or other medical conditions such as diabetes or if you are overweight or smoke. Occasionally patients die from major surgery. Your surgeon will discuss these risks with you. What will I feel like after the operation? You will have had a fairly long operation under a general anaesthetic so you will probably feel drowsy for most of the day. If your neck dissection forms part of a more major operation you may spend the first night, and occasionally longer, in the Critical Care Unit, also called Intensive Care or High Dependency Unit. You will usually have what is commonly called a drip attached to your arm to give you fluid until you are able to drink enough. You will also have one or two plastic tubes called drains in your neck close to the incision; these drains are placed to drain any blood or fluid that seeps underneath the skin and therefore reduce the risk of swelling and infection. The drains will be easily removed within a few days as the drainage into them stops. Most people do not experience much pain from their surgery, but if it does hurt, this can be well controlled with pain killers which you will be offered. You must tell the staff if you feel that you need more. How long will I be in hospital? This depends upon whether your neck dissection is being performed on its own, or as a part of a more major procedure. If it is the only procedure, you can expect to need a hospital stay of between three and five days. If you are having a more major procedure, your surgeon should be able to give you an estimate of the total length of stay. Will I be able to eat and drink after my operation? Yes. As long as this is your only operation, you should be able to eat or drink the same day. If more extensive surgery has been undertaken, you will normally have to wait a bit longer. 4

6 How long will I need off work? This is different for every individual, but for a single neck dissection alone, you should expect to take a couple of weeks off from your job (or from looking after your home and family) after leaving hospital. The ward can provide you with a sick note certificate before you leave hospital. You will have to get any further certificates that you might need from your own GP. Will I be given tablets to take home? You will be given a few days supply of any medication that you need to take after you leave hospital, but you may need to get further supplies from your GP if needed. Will my GP be informed of my admission to hospital? Yes. Your GP will receive a standard letter from the ward soon after discharge. You will also be given a copy, so if you need to see your GP very soon after discharge please take along your copy. How should I care for the wound? Before you leave, we may ask you to arrange for your staples or sutures to be removed by your GP practice nurse a week after your surgery. You may wash the area gently and pat it dry with a clean towel but it is best not to immerse the wound until the stitches or staples are removed. The incision usually fades very well with time. Once it is fully healed, you may massage the scar with any bland skin cream. Will I be seen in the outpatient clinic following my operation? Yes, you will be given an outpatient appointment before you leave hospital. At this appointment your surgeon will inform you of the pathology results. Any further treatment that you may require will be explained to you at this visit. You may not need any further treatment at all, but we shall certainly follow you up regularly in outpatients. I still have some questions to ask, what should I do? It is important that you feel that all your questions and concerns have been dealt with satisfactorily before your operation. If you think that they have not, then please get in touch with us. You should already have been given contact details of your specialist nurse or key 5

7 worker, so that is usually the best place to start, but feel free to contact any member of the surgical team if necessary or visit any of the information centres listed overleaf. It is important that you make a list of all medicines you are taking and bring it with you to all your follow-up clinic appointments. If you have any questions at all, please ask your surgeon, oncologist or nurse. It may help to write down questions as you think of them so that you have them ready. It may also help to bring someone with you when you attend your outpatient appointments. For details of local cancer support groups and organisations, please ask your head and neck nurse. Glossary of medical terms used in this information: Hypoglossal nerve: a nerve which controls movement of the tongue. Jugular vein: vein in the neck that returns blood from the head. Lingual nerve: a nerve which supplies sensation and taste to the anterior aspect of the tongue Lymph nodes: hundreds of small oval bodies that contain a fluid called lymph. These act as a first line of defence against infections. Mandibular branch of the facial nerve: the nerve which controls the small muscles that pull the corner of the mouth downwards. Pathologist: a doctor who studies disease by looking at tissues and body fluids under a microscope. Sternocleidomastoid muscle: one of two muscles in the neck that flex and rotate the head. Local support groups Please visit on our website for details of local support groups: 6

8 Local sources of further information You can visit any of the health/cancer information centres listed below: Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: Cancer Information and Support Centre Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR Telephone: Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon West Bromwich B71 4HJ Telephone: Fax: University Hospital Birmingham NHS Foundation Trust The Patrick Room Cancer Centre Queen Elizabeth Hospital Edgbaston Birmingham B15 2TH Telephone: NHS Walsall Community Health Cancer and Palliative Care Services Walsall Palliative Care Centre Goscote Lane Goscote Walsall WS3 1SJ Freephone:

9 About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how this information can be improved, please contact us via our website: This information was produced by Pan Birmingham Cancer Network and was written by Consultant Surgeons, Clinical Nurse Specialists, Allied Health Professionals, Patients and Carers from the following Trusts: Heart of England NHS Foundation Trust Sandwell and West Birmingham NHS Trust University Hospital Birmingham Foundation Trust Walsall Hospital NHS Trust We acknowledge the support of Macmillan in producing this information. Pan Birmingham Cancer Network 2010 Publication Date: November 2010 Review Date: November

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