Surgery to remove the lymph nodes in your neck | Salivary gland cancer

Lymph nodes are small bean shaped glands found throughout the body, including the head and neck area. They are often the first place cancer cells spread to when they break away from a tumour.

Surgery to remove the lymph nodes in the neck is called a neck dissection. Surgeons don’t routinely do a neck dissection on everyone because it can have long term side effects. They have to consider carefully who will benefit from it. 

You may have a neck dissection if your:

• salivary gland cancer is high grade
• lymph nodes are swollen
• scans show that the lymph nodes might have cancer cells in them

There are different types of neck dissection:  

• selective neck dissection
• modified radical neck dissection
• radical neck dissection

Partial or selective neck dissection

Your surgeon removes lymph nodes from some areas of your neck. It is usually the areas closest to the cancer. 

Modified radical neck dissection

There are 3 types of modified radical neck dissection.

With one type your surgeon removes most of the lymph nodes between your jawbone and collarbone on one side of your neck.

With the other 2 types your surgeon also needs to remove one or more of the following structures:

• a muscle on the side of your neck called the sternocleidomastoid muscle
• a nerve called the accessory nerve
• a vein called the internal jugular vein

You might have a modified radical neck dissection if the cancer is affecting more than one of the lymph nodes on your neck.

Radical neck dissection

You have nearly all the nodes on one side of your neck removed. Your surgeon will also remove:

• the sternocleidomastoid muscle
• a nerve called the accessory nerve
• the internal jugular vein

You might have a radical neck dissection if the cancer has spread to other nearby structures.

Side effects of neck dissection

The side effects depend on which structures have been removed or disturbed during surgery.

Shoulder stiffness and arm weakness

The accessory nerve controls shoulder movement. So if you have this removed, your shoulder will be stiffer and more difficult to move. If you have a partial or modified neck dissection, the weakness in your arm usually lasts only a few months. But if you have your accessory nerve removed, the damage is permanent.

Your doctor will refer you to a physiotherapist. They will show you some exercises to help improve the movement in your neck and shoulder. It is important that you do them.

Some people have problems with pain and movement a year after surgery. In this situation, your doctor may suggest a reconstruction of some of the muscles. But this isn’t suitable for everyone.

Pain

You may also have some pain. Taking painkillers can help. Physiotherapy exercises can also reduce pain. Your doctor can refer you to a pain clinic if the pain continues or is not controlled with painkillers.

A thinner, shrunken and stiff neck

Your neck will look thinner and shrunken if you have had the sternocleidomastoid muscle removed.

Your neck might be stiff after the operation and you might need physiotherapy.

Swelling (lymphoedema)

After surgery to remove some or all of the lymph nodes in your neck, the area can be swollen. This can be due to general swelling around the surgical wound. This usually goes down within a couple of weeks. But it can also be a sign of lymphoedema, this swelling doesn’t go away.

Lymphoedema means a build up of lymph fluid that causes swelling. It can develop because surgery interferes with the normal flow of lymph in the lymphatics.

Lymphoedema in the head or neck can also cause symptoms inside your mouth and throat. This may include swelling of your tongue and other parts of your mouth.

Tell your doctor or nurse straight away if you have:

• any swelling or a feeling of fullness or pressure
• find it difficult to swallow
• have changes in your voice

They will refer you to a lymphoedema specialist if they think you might have lymphoedema. It’s important to start treatment early to stop the swelling from getting worse.

Chyle leak

Chyle is tissue fluid (lymph) that contains fat after it has been absorbed from the small bowel (intestine). It gets transported through the lymphatic channels to the bloodstream.

Sometimes one of these channels, called the thoracic duct, leaks after the operation. When this happens, lymph fluid or chyle can collect under the skin.

You may need to stay longer in hospital and go back to the operating theatre to repair the leak.

Blood clot

Sometimes the tubes of the drain that the surgeon puts in during surgery can become blocked. This can cause blood to collect under the skin and form a clot (haematoma). If this happens, you might need to go back to the operating theatre to have the clot removed and the drain replaced.

Other possible effects

You might have other effects due to damage to some of the nerves that supply the head and neck area.

They include:

• numbness of the skin and the ear on the same side as the operation
• loss of movement in the lower lip
• loss of feeling or movement on one side of the tongue

Let your doctor or specialist nurse know about any side effects that you have so they can help you to cope with them.

Exercises for lymphoedema

Using your head, neck and shoulder muscles may help to reduce swelling. Your physiotherapist or specialist nurse will usually go through these exercises with you. 

These exercises shouldn’t be painful. You might have a feeling of stretching as you do them, this is normal. Stop doing the exercises if you have any pain and, if doesn’t get better contact your doctor.

Do the exercises slowly and gently, don’t rush them. You can rest between exercises. It might help to do them in front of the mirror so you can check that your shoulders are back and relaxed. 

Transcript

Hi, I’m Carla. I’m going to show you how to do head and neck exercises. Remember to do your deep abdominal breathing exercises before and after. Each exercise you will do 5 to 10 times and very important , pain free.

Neck exercises

We’ll start with the head and neck. We’ll do looking to the side, back to the middle and to the other side. It’s normal to feel a bit of stretch sensation.

Next one will be ear to the shoulder, not shoulder to the ear. Go back to the middle and to the other side. If you’re not sure you’re doing it right, sometimes it’s helpful to do it in front of a mirror.

Next one will be chin to the chest and back to start position.

Shoulder exercises

Next one will be shoulders. We’ll go up, relax and down and relax.

Next one will be circles. And we go backwards and then forward.

Mouth exercises

We’ll do as well mouth exercises. We’ll start with open and close. Blowing kisses, blowing candles, exaggerated smile. And then you say the vowels in an exaggerate way

Jaw exercises

And we’ll do as well the jaw exercises. We’ll do side to side first.

And then moving the jaw forward and the back to normal.

Remember to do the deep abdominal breathing at the end, repeat them once a day minimum and if you have any concerns just call your doctor or lymphoedema specialist.

Find out more about lymphoedema on the Cancer Research UK website.

• Salivary gland cancer: ESMO-European Reference Network on Rare Adult Solid Cancers (EURACAN) Clinical Practice Guideline for diagnosis, treatment and follow-up
  C van Herpen and others
  Practice Guideline ESMO Open, 2022. Vol 7, Issue 6

• Neck dissection for salivary gland malignancies
  S Byrd and L Morris
  Operative Techniques in Otolaryngology Head Neck Surgery, 2018. Vol 29, Issue 3, Pages 157-161

• Management of Salivary Gland Tumours: United Kingdom National Multidisciplinary Guidelines
  S Sood and others
  The Journal of Laryngology & Otology, 2016. Vol. 130, Suppl S2

• Surgery in head and neck cancer: United Kingdom National Multidisciplinary Guidelines
  J Homer
  The Journal of Laryngology & Otology, 2016. Vol 130, Suppl S2

• Lymphedema Outcomes in Patients with Head and Neck Cancer
  B Smith and others
  Otolaryngology Head and Neck Surgery, 2015. Vol 152, Issue 2

• The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact [email protected] with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 

21 Apr 2023

Next review due: 

21 Apr 2026

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Neck dissection | Canadian Cancer Society

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3. Tests and procedures

4. Neck dissection

Diagram of the levels of cervical lymph nodes

A neck dissection is done to:

• check for cancer in the lymph nodes in the neck
• remove lymph nodes that may contain cancer
• remove lymph nodes when there is a high chance cancer will spread to them
• reduce the chance that the cancer will come back (recur)
• remove cancer that is still in the lymph nodes after radiation therapy or chemotherapy
• help doctors plan further treatment

A neck dissection is done under general anesthetic in a hospital operating room. In head and neck cancer, you will have lymph nodes removed on one side of the neck (ipsilateral neck dissection) or both sides of the neck (bilateral neck dissection). This is done for tumours that are very likely to spread or have already spread to one or both sides of the neck.

You may have a neck dissection at the same time as surgery to remove the main tumour or as a separate surgery. The surgeon makes a cut (incision) in the neck to remove the lymph nodes. Depending on the type of neck dissection surgery, the surgeon may also remove other tissue in the area.

Selective neck dissection removes only those lymph nodes where cancer is very likely to spread. How many and which lymph nodes are removed is based on the size and location of the primary tumour. The muscle and nerve tissue around the lymph nodes are not removed to maintain proper function of the neck and shoulder. A selective neck dissection is also called a functional neck dissection.

Modified radical neck dissection removes lymph nodes from levels I to V, but keeps one or more of the following – internal jugular vein, sternocleidomastoid muscle or spinal accessory nerve.

Radical neck dissection removes nearly all lymph nodes on one side of the neck as well as the internal jugular vein, sternocleidomastoid muscle and spinal accessory nerve.

After removing the lymph nodes, the surgeon places a small tube (drain) in the wound and closes the cut with stitches or staples. A drainage bag is attached to the end of the tube to collect fluid draining from the area. This reduces the chance of fluid building up in the tissue and improves healing. The drain is left in place for a few days or until there is little drainage.

After a neck dissection, you may need to stay in the hospital for a few days. You may be given:

• antibiotics to prevent infection (if the primary tumour is removed at the same time)
• pain-relieving medicine
• instructions on caring for and dressing the wound
• advice on how much and which types of activity you can do after surgery
• advice on body positions that may help reduce swelling
• a follow-up appointment to see the surgeon in 1–2 weeks
• information about which symptoms and side effects you should report

The lymph nodes and any other tissue removed during surgery are sent to a lab to be examined by a doctor who specializes in the causes and nature of disease (pathologist).

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after a neck dissection. Sometimes late side effects develop months or years after a neck dissection. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Tell your healthcare team if you have these side effects or others you think may be from a neck dissection:

• pain and stiffness
• bruising
• signs of infection, such as pain, redness, yellow discharge (pus) or fever
• a collection of fluid under the skin (seroma) in the neck near the cut
• swelling due to a buildup of lymph fluid in the soft tissues (lymphedema)
• changes in the shape of the neck
• shoulder pain and a change in the normal shape, with some weakness on the side of the surgery

The healthcare team may give you antibiotics to prevent or treat an infection, or they may drain a buildup of fluid. Lymphedema treatment may include massage therapy and exercises.

Each lymph node removed is examined to see if it contains cancer.

• A negative lymph node has no cancer cells.
• A positive lymph node has cancer cells.

The pathologist’s report includes the type of cancer, the number of lymph nodes removed and the number of lymph nodes that have cancer cells. The report may also say if the cancer has grown through the outer covering of the lymph node (the capsule).

Doctors use the number of positive lymph nodes to help stage the cancer. They use the stage along with other information about the type and grade of the cancer to make treatment decisions and give a prognosis.

Depending on the result, your doctor will decide if you need more tests, any treatment or follow-up care.

In rare cases, a neck dissection may be done in children to treat cancers that may spread to lymph nodes in the neck, such as melanoma or thyroid cancer.

Preparing children before a test or procedure can lower anxiety, increase cooperation and help them develop coping skills. Preparation includes explaining to children what will happen during the test, including what they will see, feel, hear, taste or smell.

Preparing a child for a neck dissection depends on the age and experience of the child. Find out more about helping your child cope with tests and treatment.

• French JC1, Rowe MR, Lee TJ, et al
  . Pediatric melanoma of the head and neck: a single institutions experience. Laryngoscope. 2006.

• Harisk,K.
  . Neck dissections: radical to conservative. World Journal of Surgical Oncology. Biomed Central; 2005: http://www.wjso.com/home/.

• Newkirk KA, Holsinger FC
  . Cancers of the head and neck. Feig BW & Ching CD. The MD Anderson Surgical Oncology Handbook. 5th ed. Lippincott Williams & Wilkins; 2012: 6: 196-219.

• Shaha,A.R.
  . Neck dissection: an operation in evolution. World Journal of Surgical Oncology. Biomed Central; 2005: http://www.wjso.com/home/.

• Werning,J.
  . Modified radical neck dissection. eMedicine.Medscape.com. WebMD LLC; 2010: http://emedicine.medscape.com/.

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Neck pain: causes, symptoms, treatment

Neck pain with varying frequency in 70% of adults. At the same time, pain can not only be of a different nature, but also be caused by a variety of diseases. Therefore, they are generally not observed in isolation, but are accompanied by other symptoms that help to correctly diagnose and select the optimal treatment tactics.

TYPES OF PAIN IN THE NECK

1. 1. acute (lasting less than 10 days)
2. 2 . chronic
3. 3. vertebrogenic – arising against the background of pathological changes in the cervical spine, including damage to the intervertebral discs, compression of the spinal roots and spinal cord
4. 4. non-vertebrogenic – resulting from all other causes, including infectious diseases , inflammatory processes in the muscles, diseases of the thyroid gland, lymph nodes, etc.

SIGNS OF VERTEBROGENIC PAIN

1. 1. Irradiation (spread of pain outside the affected area or organ) to the occipital region, shoulders, arms, up to the hands and fingers. Often, numbness, impaired sensitivity and mobility are observed, which indicates the development of neurological disorders, i.e., infringement of one or another anatomical structure of the nerve roots or spinal cord.
2. 2. Dizziness, blackouts and headaches may occur, indicating compression of the vertebral arteries, such as a herniated disc.

An urgent appointment with a neurologist is necessary if the pain in the neck is acute or accompanied by dizziness, numbness in the back of the head, tinnitus.

PAIN IN THE FRONT OF THE NECK

The occurrence of unpleasant or even painful sensations directly in the area under the chin or diffuse pain along the entire front of the neck may indicate:

1. 1. diseases of the thyroid gland;
2. 2. inflammatory processes in the muscles affecting the ligaments and nerves;
3. 3. formation of cysts and abscesses;
4. 4. lymph nodes affected;
5. 5. angina pectoris;

That is, the list of possible causes is quite extensive and it is impossible to independently determine what exactly caused the pain in the neck. In such situations, it is worth contacting a therapist for an examination. If necessary, the doctor will refer the patient to a specialist of the required profile.

6. vertebral artery syndrome

7. radicular syndrome.

In both cases, the cause is entrapment of blood vessels or nerves by a deformed intervertebral disc, edematous tissues, a displaced cervical vertebral body, or other structure. In such situations, it is necessary to contact the doctor neurologist .

In the medical center “Quality of Life” an appointment is conducted by a neurologist of the highest category Gudovshchikova Lyubov Sergeevna.

PAIN IN THE BACK OF THE NECK, CAUSES

Due to the peculiarities of the modern lifestyle, people are very often worried about pain in the back of the neck. Work at the computer, constant use of gadgets, low level of physical activity and bad habits, all this causes pathological changes in the structure of the spine, which manifest themselves as pain in the neck. Therefore, in the event of aching, pulling, sharp pains, backaches in the back of the neck, consultation is first of all required neurologist , since in the overwhelming majority of cases this indicates diseases of the cervical spine, namely: 005 3. herniated discs

In the medical center “Quality of Life” an appointment is conducted by a neurologist of the highest category Gudovshchikova Lyubov Sergeevna.

PAIN IN THE SIDE OF THE NECK, CAUSES

Most often, pains in the lateral surfaces of the neck are burning or throbbing, they can also be of a tingling nature. They tend to radiate to the shoulder and ear, sometimes accompanied by the formation of secondary torticollis, as a result of which the head leans to the affected side.

Similar typical for:

1. 1. pathologies of the blood vessels, including atherosclerosis;
2. 2. muscle spasms, which can be provoked by a strong load on the neck, sudden movement or hypothermia;
3. 3. malignant growths in the thyroid gland, pharynx and larynx.

WHICH DOCTOR TO GO TO FOR NECK PAIN

0005 neurologist . The doctor, based on complaints, examination data and neurological tests, will be able to determine whether the discomfort in the neck is really due to disorders in the spine or is it caused by other diseases.

Nevertheless, deviations from the norm in the state of the spine, in fact, are one of the reasons for the development of concomitant diseases of internal organs. After all, a change in the position of the vertebrae, a decrease in the height of the intervertebral discs and other, even minor changes, lead to a disruption in the transmission of nerve impulses from the spinal cord through the nerve roots along the nerves to the internal organs. Since the spinal cord is distinguished by segmental innervation, i.e., each of its parts is responsible for the correct functioning of a particular organ, if disorders occur in the cervical spine, the innervation of the ENT organs, vocal cords, thyroid and parathyroid glands, as well as neck muscles can suffer , shoulders and forearms. Therefore, initially their work is disrupted, and over time, organic changes also occur, that is, one or another disease develops, which can provoke pains of varying intensity and nature in the neck.

Therefore, diseases of the internal organs are extremely rarely diagnosed and changes in the spine are not detected, and therefore a consultation with a neurologist is required without fail. But if the patient has signs of diseases of the thyroid gland, heart, ENT organs or others, he is additionally shown to receive advice from narrow specialists (endocrinologist, cardiologist, otolaryngologist, etc.).

Thus, neck pain is a widespread phenomenon. They can be caused by the development of various diseases, but most often the discomfort is based on problems with the spine caused by a sedentary lifestyle. Therefore, you should not hesitate to contact a doctor. Indeed, in the early stages of the development of the disease, it can be easily dealt with by conservative methods. While in advanced cases, pain in the neck and the causes that cause it can be eliminated exclusively by surgery.

In the medical center “Quality of Life” a doctor of the highest category sees a neurologist. Provides assistance to patients with diseases of the central and peripheral nervous system, and also provides treatment using modern methods.

Cost of consultation 1100 rub

There are contraindications. Specialist consultation is required.

removal operation in Moscow at the FSCC FMBA of Russia

Median cyst of the neck is a benign tumor-like formation, which is covered with a capsule on the outside, and inside contains a cavity with liquid contents. Neck cysts are a congenital pathology. The median cyst of the neck belongs to the anomalies in the development of the gill slits.

Median cysts are located on the anterior surface of the neck between the hyoid bone and the thyroid cartilage, the position may change and be located slightly to the side.

Median cysts are often asymptomatic. Symptoms appear with inflammation (suppuration) of cysts, which can lead to the formation of a fistulous canal, or at large sizes, when the formation compresses the main vessels and nerves of the neck.

With inflamed median cysts, patients note pain, swelling and redness of the skin on the neck. Patients may also report difficulty or discomfort when swallowing. Often the first symptom is the appearance of a nodular formation (“bump”) in the upper third of the anterior surface of the neck, as a rounded formation.

For the diagnosis of median cysts, a multiple approach is required using MRI / CT of the neck with contrast, ultrasound of the soft tissues of the neck. As well as a fine-needle aspiration biopsy for cytological examination in order to confirm the diagnosis.

Indications for surgery

– Median cysts of the neck

How to prepare

Removal of the median cyst of the neck is preceded by a consultation with a doctor in the Department of Head and Neck Pathology. Standard laboratory and instrumental diagnostics, as well as MRI and / or CT with contrast of the neck, ultrasound of the soft tissues of the neck, fine-needle aspiration biopsy with subsequent cytological examination.

It is recommended to inform the surgeon about the medications taken and about intolerance (allergic reactions) to medications. It is necessary to stop taking blood-thinning drugs a few days before surgery in agreement with the cardiologist, since the risk of bleeding increases while taking these drugs.

In general, preoperative preparation is aimed at ensuring patient safety, successful surgical treatment and reducing the risk of postoperative complications.

How is the treatment

Treatment of median cysts of the neck is carried out only surgically. In order to avoid complications in the form of suppuration or compression of the main vessels and nerves of the neck, it is better to remove the cyst as soon as possible.

The operation takes place under general anesthesia. The duration of the surgical intervention is about 60 minutes and depends on the location of the median cyst, the complexity of the particular case. The surgeon makes an incision on the front surface of the skin of the neck along one of the skin folds so that after the operation there are no rough scars. Next, the neoplasm is isolated from the surrounding tissues and removed. The surgical wound is sutured with a cosmetic suture.

Contraindications for surgery

There are no absolute contraindications for surgical treatment.

Possible complications

Infection of the postoperative wound in case of removal of an inflamed median cyst

Recovery after surgery

At the end of the operation, the patient is given antibacterial, anti-inflammatory treatment.

The length of stay in the hospital depends on the type of operation, but usually does not exceed 3 days.

The doctor will schedule a follow-up visit to change the bandage, examine the postoperative sutures, monitor the condition, and remove the sutures.

After removal of the median cyst, a feeling of pain, discomfort, general malaise is possible. Over-the-counter pain medications prescribed by your doctor can be used to relieve symptoms.

Treatment of the median cyst in the Federal Scientific and Practical Center

Surgeons-oncologists / maxillofacial surgeons of the Federal Scientific Clinical Center treat patients with various pathologies of the head and neck organs. The advanced equipment of the department, the laboratory and instrumental capabilities of the medical center, many years of clinical experience of specialists are the factors that ensure the high-quality performance of surgical treatment, as well as monitoring the condition after surgery and timely correction of possible complications.