Treatments & Therapies

Neck dissection – treatment, effect and risks


neck dissection is understood to mean surgical removal of the lymph nodes in the neck and the adjacent tissue. The procedure is used to treat lymph node metastases in the neck area.

What is a neck dissection?

The term neck dissection comes from the English and means translated neck preparation . What is meant by this is a radical surgical method in which the surgeon removes all the lymph nodes in the head and neck region because a primary tumor is present.

This is to prevent the tumor cells from spreading further in the body. In medicine, a distinction is made between prophylactic and therapeutic neck dissection. A prophylactic neck dissection is when the lymph nodes are removed even if no metastases can be detected in them. With this procedure, the surgeon operates on micrometastases that are not visible. If, on the other hand, evidence of secondary tumors could be provided, it is a therapeutic neck dissection.

Function, effect & goals

The most important area of ​​application for neck dissection is the existence of metastases in the lymph nodes in the neck area if the primary tumor is known. However, the procedure is also performed when the primary tumor has not yet been identified, but secondary tumors are present.

Metastases are often seen in cancers that occur in the head and neck region. Sometimes the people affected also suffer from tumors in the urinary tract , in the abdomen or in the chest region, such as bronchial carcinoma . The most common tumor diseases that lead to the formation of metastases include malignant salivary gland tumors, laryngeal carcinoma, pharyngeal cancer , malignant tumors in the nose or paranasal sinuses and neoplasms within the oral cavitysuch as a tongue base carcinoma or a tonsil carcinoma. In most cases, a neck dissection is combined with subsequent radiation therapy of the primary tumor and the lymphatic drainage regions in the neck area.

Doctors distinguish between different forms of neck dissection. These are the radical, the functional, the selective and the suprahyoid neck dissection, which have different surgical techniques. The radical neck dissection includes the removal of all lymph nodes and lymphatic vessels in the neck area and adjacent tissue. In addition, important nerves and blood vessels are often removed, which in turn increases the risk of complications. This radical surgical method is primarily used when the lymph nodes are severely affected by metastases.

Functional neck dissection is less radical. Structures such as the accessory nerve, the internal jugular vein and the muscles are preserved. Functional neck dissection is performed when the lymph node metastases are not fixed.

A selective neck dissection refers to the removal of individual sections of the neck. Some primary tumors only affect certain lymph node areas. For this reason, doctors divide the cervical lymph node regions into six special levels. A selective neck dissection is performed for lymph node metastases that cannot be detected.

Another form is the suprahyoid neck dissection. It is primarily used for carcinoma of the floor of the mouth, carcinoma of the lip or cancer of the tongue . The hyoid bone (Os hyoideum) marks the border of this clearance.

Before the neck dissection, the patient is given general anesthesia. The surgeon then makes an incision in the head nod muscle. This is located in the lateral neck region. On one or both sides of the neck, the surgeon removes the lymph nodes as well as the lymph vessels. The number of lymph nodes and vessels removed depends on their involvement. In some cases, an operative expansion in the direction of the collarbone may also be necessary. If necessary, the doctor operates on other parts of the tissue in the adjacent area. This can include glands, nerves , vessels, muscles or other lymph nodes.

In the case of a radical neck dissection, the surgeon also removes anatomical structures such as the sternohyoid muscle (breastbone-hyoid bone muscle), the sternothyroid muscle (breastbone-thyroid cartilage muscle), the omohyoid muscle (shoulder-hyoid bone muscle), and the sternocleidomastoid muscle (head nodding muscle), the internal jugular vein (internal jugular vein), the accessory nerve and the submandibular gland (lower jaw salivary gland). This leads to an extensive loss of tissue, which also impairs the patient’s functionality. If complications occur, further surgical measures may be necessary.

Risks, side effects & dangers

Various complications are possible as a result of a neck dissection, the extent of which often depends on the extent of the intervention.

If the lymph nodes are removed superficially for diagnostic purposes, the negative side effects are considered less pronounced and are attributed to general surgical risks. However, if an extensive procedure is carried out in which deep-seated lymph nodes are removed, the risk of serious impairments increases. However, if gentle surgical methods are used and the surgeon has sufficient experience, the risk can be minimized.

The general surgical risks include wound healing disorders, bleeding , post-operative bleeding, the formation of scars, inflammation, sensitivity disorders on the skin and wound retention, which may require another operation.

Furthermore, injuries to larger neck vessels are possible as a result of a neck dissection. In rare cases, life-threatening bleeding occurs that needs to be treated with a blood transfusion . The risks of the procedure also include damage to the deep veins in the neck. These in turn cause failures in the face, vocal cords, tongue, arm or diaphragm. If large amounts of tissue are removed as part of the neck dissection, this sometimes results in noticeable changes in shape.

Following the neck dissection, the patient must rest their neck and head and avoid jerky movements. In the wound area, washing and shaving should be temporarily avoided.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.