Learn more about why neck dissection is performed.
The primary role of the 600 lymph nodes located throughout the body is to filter and trap potentially harmful particles. Immune cells within these structures also help the body defend itself against infections. If cancer affects any of the 200 lymph nodes found within the head and neck area, a surgical procedure referred to as neck dissection may be performed.
During the operation, bean-shaped lymph nodes and surrounding tissues are removed in the affected area.
This is done to prevent cancer cells from spreading to healthy glands.
The lymphatic system transmits a liquid called lymph that contains the immune system’s infection-fighting white blood cells. This means cancer can spread to other lymph nodes and organs, even ones far away from the affected site. When head and neck cancer involves the lymph nodes, neck dissection is done to remove malignant tissues and collect other tissues from nearby glands to prevent cancer from spreading via the lymphatic system.
Radical, Modified, and Selective Dissections
A radical dissection involves complete removal of lymph nodes within the affected area. The drawback of this approach is that the appearance of the face may be altered after structures are removed. Some patients may also have issues with limited range of motion in arms or shoulders.
With a modified dissection, an effort is made to preserve the nearby internal jugular vein, sternocleidomastoid muscle, and accessory nerve. Also, only certain groups of lymph nodes are removed, which results in less tissue removal.
A selective dissection is usually recommended when head or neck cancer is detected early. With this approach to dissection, only certain lymph nodes are removed instead of removing nodes from all zones.
How Neck Dissection Is Performed
Lymph nodes are arranged in groups called zones. Prior to the procedure, an ear, nose, and throat specialist may examine the larynx and other structures around the affected nodes to determine what tissues to remove. The extent of the neck dissection will depend on factors such as the stage and type of cancer and whether or not affected tissues within the area were detected with image tests.
Performed under general anesthesia, neck dissection requires an incision made within the neck’s skin crease. The incision is usually made vertically on the side to allow for better visualization and reduce the risk of damage to important nerves, muscles, and veins. The dissection takes place under a layer of fat and muscle where the lymph nodes are located.
After the Procedure
Oftentimes, tissues heal well following a neck dissection. There may be some visible scarring. However, significant scarring can be corrected with cosmetic surgery. Even when the sternocleidomastoid muscle has to be removed, most patients will not notice a significant reduction in muscle strength.
Neck dissection is both a treatment and a preventative measure. Because of the way cancer metastases (spreads), it can be difficult to tell if lymph nodes without obvious signs of abnormal growths are “clean" with a visual inspection during surgery. Testing the removed glands can determine if further treatment, which may include chemotherapy and radiation therapy, will be necessary. The preferred methods of dissection today are modified or selective procedures that minimize the risk of impacting nerve and muscle functions while preserving as much tissue as possible.