FAQ28: What is a Neck Dissection?
by Dr. Glenn Peters
Answer - as follows:
That's a big topic so I'll hit the highlights.
Simply put, a neck dissection is an operation that is done to remove the lymph nodes in the neck. There a two fundamental types of neck dissections: one that is done when we know there is cancer present in the lymph nodes ("therapeutic" neck dissection) or one that is done when there is a high likelihood that microscopic disease may be present in the nodes, even though we can't feel them or they don't show up on scans ("elective" neck dissection).
Now, let's take this a little further. Therapeutic neck dissections vary depending on the amount of cancer that may be present in the nodes. Large, bulky nodes may require a "radical" neck dissection for complete removal. The radical neck dissection was first used in the first decade of the 20th century and has changed little since it was originally described. The radical neck dissection is the most comprehensive operation that can be done for cancer in the cervical nodes. It is a complete clean out of all node bearing groups and also involves the removal of the internal jugular vein, the sternocleidomastoid muscle, and the spinal accessory nerve that goes to the trapezius muscle. Obviously, this can result in a cosmetic deformity in the neck and more importantly weakness in raising the shoulder and arm from sacrifice of the spinal accessory nerve.
Smaller nodes and elective neck dissections can be handled with a "functional or modified" neck dissection. This is a more targeted operation wherein the nodes that are either involved and/or at highest risk for involvement are removed. In doing the modified operation you usually leave the jugular vein, the stercleidomastoid muscle, and the spinal accessory nerve. This results in less cosmetic deformity and less problems with your shoulder.
Neck dissections can be done either when the larynx is removed or later if nodal metastases appear. More and more, we are doing elective operations at the same time we operate on the larynx. We have found that this gives us important information about the status of the nodes (whether there is microscopic disease) and also whether we need to use radiation after surgery. So that's neck dissections in a nutshell.
Glenn E. Peters, M.D. , F.A.C.S.
Director, Division of Otolaryngology - Head and Neck Surgery
University of Alabama at Birmingham, Birmingham, Alabama, USA