Neck Dissection: Treatment, Effect & Risks

Neck dissection refers to surgical excision of the neck lymph nodes and adjacent tissue. The procedure is used to treat lymph node metastases in the neck.

What is neck dissection?

The term neck dissection comes from the English language and means neck dissection. It refers to a radical surgical method in which the surgeon removes all 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 performed when the lymph nodes are removed even if no metastases can be detected in them. By this procedure, the surgeon operates out micrometastases that are not visible. If, on the other hand, the daughter tumors could be detected, this is a therapeutic neck dissection.

Function, effect, and goals

The most important field of application of neck dissection represents the existence of metastases of the lymph nodes in the neck area, if the primary tumor is known. However, the procedure is also practiced when the primary tumor has not yet been identified but daughter tumors are present. Metastases often show up in cancers that occur in the region of the head and neck. Sometimes affected individuals also suffer from tumors in the urinary tract, abdomen or chest region such as bronchial carcinoma. The most common tumor diseases that lead to the formation of daughter tumors include malignant salivary gland tumors, laryngeal carcinoma, pharyngeal cancer, malignant tumors in the nose or paranasal sinuses, and neoplasms within the oral cavity such as carcinoma of the base of the tongue or tonsillar carcinoma. In most cases, neck disscetion is associated with subsequent radiation therapy of the primary tumor as well as the lymphatic drainage regions in the neck. Doctors distinguish between different forms of neck dissection. These are the radical, the functional, the selective as well as the suprahyoid neck dissection, which have different surgical techniques. Radical neck dissection involves the removal of all lymph nodes and lymph vessels in the neck area along with adjacent tissue. In addition, significant nerves and blood vessels are often operated out, which in turn creates a higher risk of complications. This radical surgical method is primarily used when there is a severe involvement of the lymph nodes with metastases. Less radical is the functional neck dissection. In this way, structures such as the accessorius nerve, the internal jugular vein and the muscles are preserved. Functional neck dissection is performed when lymph node metastases are not fixed. Selective neck dissection is when single neck sections are excised. In this case, only certain lymph node areas are affected by some primary tumors. For this reason, doctors divide the neck 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 tongue cancer. The hyoid bone (Os hyoideum) marks the border of this excision. Before neck dissection, the patient receives general anesthesia. Following this, the surgeon makes an incision in the head-nicker 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, surgical extension toward the collarbone may also be necessary. If necessary, the physician will operate to remove other parts of the tissue in the adjacent area. This may include glands, nerves, vessels, muscles or other lymph nodes.In the case of a radical neck dissection, the surgeon additionally removes anatomical structures such as the sternohyoideus muscle (sternocleidomastoid muscle), the sternothyroideus muscle (sternocleidomastoid cartilage muscle), the omohyoideus muscle (shoulder hyoid muscle), the sternocleidomastoid muscle (head nodder muscle), the internal jugular vein (internal jugular vein), the accessorius nerve, and the submandibular gland. This leads to an extensive loss of tissue, which also limits the patient functionally. If complications occur, further surgical measures may be required.

Risks, side effects, and hazards

Various complications are possible as a result of neck dissection, the extent of which often depends on the extent of the procedure. If it is a superficial removal of the lymph nodes for diagnostic purposes, the negative side effects are considered less pronounced and are attributed to general surgical risks. However, if an extensive operation is performed in which deep-seated lymph nodes are removed, the risk of serious adverse effects increases. However, if gentle surgical methods are used and the surgeon has sufficient experience, the risk can be minimized. General surgical risks include wound healing problems, bleeding, post-operative bleeding, the formation of scars, inflammation, sensory disturbances on the skin, and wound retention that may require further surgery. Furthermore, injuries to major neck vessels are within the realm of possibility due to neck dissection. In rare cases, life-threatening bleeding occurs and must be treated with a blood transfusion. The risks of the procedure also include damage to the deep neck veins. These, in turn, cause failures of the face, vocal cords, tongue, arm or diaphragm. If large amounts of tissue are removed during neck dissection, this sometimes results in noticeable changes in shape. Following neck dissection, the patient must take care of the neck and head and refrain from jerky movements. Washing and shaving should be temporarily avoided in the wound area.