Cancers of the mouth and oropharynx can spread to the lymph nodes in your neck. Your surgeon may remove some or all of the lymph nodes in your neck.
Surgery to remove lymph nodes in the neck is called a neck dissection. Surgeons don't usually perform a neck dissection on everyone because it can have long-term side effects.
You may have a sentinel lymph node biopsy (SLNB). This is a test to find the first lymph node or nodes to which a cancer may have spread. The doctor then checks whether this lymph node contains cancer cells.
Why do you need surgery to remove lymph nodes?
Lymph nodes are small bean-shaped glands found throughout the body, including the head and neck area. They are part of the lymphatic system that filters body fluids and fights infection. They also trap damaged or harmful cells such as cancer cells.
It is often the first place cancer cells spread to when they are removed from a primary cancer.
Your doctor needs to find out if the lymph nodes in the neck contain cancer. It is important to know this in order to determine the stage of the cancer and plan treatment.
Before the operation, your surgeon may know that there is cancer in your lymph nodes. In this case, the surgeon removes your lymph nodes during the operation to remove the cancer.
Sometimes your surgeon doesn't know if there are cancer cells in your lymph nodes before you have surgery. In this case, your surgeon may remove the lymph nodes closest to the cancer. They send the nodes to the lab to check them for cancer cells.
For early-stage cancer, your doctor may recommend a sentinel lymph node biopsy.
- Learn about the stages of oral cancer and oropharyngeal cancer
Checking your lymph nodes (sentinel lymph node biopsy)
Sentinel lymph node biopsy (SLNB) is a test to find the first lymph node or nodes to which the cancer may have spread. The doctor then checks whether these lymph nodes contain cancer cells.
This is usually for people with early-stage oral cancer.
You may have a sentinel biopsy at the same time as the operation to remove the cancer.
How do you do a sentinel lymph node biopsy?
Before your sentinel lymph node biopsy
The day before or the morning of the operation you have a scan to show where the sentinel nodes are. You usually have this in the nuclear medicine department at the hospital. This scan shows the surgeon which lymph nodes to remove, but does not tell them if the nodes contain cancer.
You inject a small amount of mildly radioactive liquid into the area near the cancer. The radioactive liquid is called a tracer.
Then you have a scan. This catches the radioactive fluid and traces it as it moves through the lymph vessels and into the lymph nodes. The first nodes to which the tracer is drained are the sentinel nodes. The radiographer can mark where these nodes are on your skin.
The scan may take approximately 90 minutes, but this time may vary. You can then go straight to the ward to prepare for surgery. Or you can go home and come back the next day for your surgery.
What happens;
Your surgeon removes sentinel lymph nodes during surgery to remove oral cancer. During the operation, your surgeon also injects a small amount of blue dye around the cancer. The dye and tracer help the surgeon identify the sentinel node.
Your surgeon usually removes 1 to 3 nodes. They send the lymph nodes to the lab to check for cancer cells.
After sentinel lymph node biopsy
Depending on the type of surgery you have for your cancer, you may go home the same day or the next day.
As you have had a general anaesthetic, you will need someone to take you home and stay with you for 24 hours after the operation.
You usually get the results about 1 to 2 weeks after surgery.
Possible problems
Pain
You may have pain around the sentinel lymph node biopsy site in your neck. This can take up to 2 weeks. Taking mild pain relievers may help. You may also have a stiff or sore throat. This usually improves in a few weeks.
Swelling
Fluid collection near the wound can cause swelling and pain. It also increases the risk of infection. This usually starts to go away soon after surgery, but may take longer.
If you have had some or all of the lymph nodes in your neck removed, the swelling may be due to lymphedema. Lymphedema means a buildup of lymph fluid that causes swelling in a part of the body. Pronounced limf-o-dee-ma.
Lymph nodes are part of your body's drainage system. Their removal can interfere with the natural circulation and drainage of tissue fluid.
You should tell your doctor or nurse about any swelling you have.
Blue or green urine
The blue dye is removed by the kidneys and can make your little one look blue or green. This usually lasts for a few days.
Rarely some people are allergic to blue because it is important to tell your surgeon if you have any allergies in advance.
What happens next?
A positive result means that there are cancer cells in the sentinel nodes. This means the cancer has started to spread. Your doctor will talk to you about further treatment. They may recommend that you have:
- surgery to remove all the lymph nodes in your neck (neck dissection)
- radiation therapy in the neck area
A negative result means there are no cancer cells in the sentinel nodes. This means the cancer is unlikely to have spread to other lymph nodes.
Dissecting the neck
Surgery to remove lymph nodes in the neck is called a neck dissection.
You may need to have lymph nodes removed from just one side of your neck, or you may need to have them removed from both sides.
There are several types of neck dissection:
- selective neck dissection
- modified radical neck dissection
- radical neck dissection
Selective neck dissection
Your surgeon removes some lymph nodes from your neck. They usually remove the nodes near the cancer that are most likely to be affected by the cancer
You may have an elective neck dissection if doctors know or suspect that only a small number of lymph nodes contain 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 must also 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
Radical neck dissection
You have removed almost all the nodes on one side of your neck. Your surgeon will also remove:
- the sternocleidomastoid muscle on the side of your neck
- a nerve called the accessory nerve
- the internal jugular vein
You usually have surgery to remove the cancer at the same time as your neck surgery.
Possible side effects after neck dissection
This operation has some side effects. These depend on which nerves or muscles the surgeon removes.
Blood clot
During the operation, your surgeon puts a drain in your throat. Any fluid around your neck goes down the drain into a bottle attached to the drain. This helps prevent blood clots from forming. But sometimes blood can collect under the skin and form a clot (hematoma). You may need to return to surgery to remove the clot if this happens.
Nerve damage
Shoulder stiffness and arm weakness
The accessory nerve controls movement of the shoulder. So if the surgeon removes it, your shoulder will become stiffer and harder to move. Raising your arm above your head on that side may also become more difficult.
After an elective neck dissection, the weakness in your arm usually only lasts for a few months. But if the surgeon completely removes your accessory nerve, the damage is permanent. Typically, you see a physical therapist, who teaches you exercises to help improve movement in your neck and shoulder. It is important to do these exercises regularly.
Some people still have problems with pain and movement a year after surgery, despite doing their exercises. If this happens, your surgeon may refer you to a shoulder surgery specialist.
Other possible effects of nerve damage
Cranial and spinal nerves supply the head and neck region. Neck dissection can damage some of these nerves. If this happens, you may have:
- numbness in the ear on the same side as the operation
- loss of movement in the lower lip
- loss of movement on one side of the tongue
- loss of sensation on one side of the tongue
Pain
You may also have some pain. Taking pain medication may help. Physical therapy exercises can also reduce pain. Your doctor may refer you to a pain clinic if the pain persists or is not controlled with pain medication.
Stiff neck
You may have a stiff neck after surgery. Your physical therapist will show you some exercises to help you improve it. It may take a few weeks or longer for your neck to be less stiff. You may need to continue the exercises after you go home.
Numbness around the scar line
This will improve over time, but for some people, it may not go away completely.
Chyle Leakage
Chyle is milky fluid that is carried throughout the body by the lymphatic system. Rarely one of the lymph channels (called a thoracic duct) leaks after this procedure. This can cause pulp to collect under the skin. You are usually on bed rest in the hospital until it stops.
Some people may need to return to surgery if the leakage continues.
Removing the muscle on the side of your neck (sternocleidomastoid muscle)
Removing the muscle on the side of your neck usually doesn't cause a problem. But it makes your neck look slimmer and sunkissed on that side.
You may dissect the neck on both sides, this means removing both muscles. Next, you may have some difficulty bending your head forward. Physiotherapy can help improve movement and prevent stiffness.
Swelling (lymphedema)
After surgery to remove some or all of the lymph nodes in your neck, the area may swell. This may be due to general swelling around the surgical wound. This usually subsides within a few weeks. But it can also be a sign of lymphedema, this swelling does not go away.
Lymphedema in the head or neck can also cause symptoms in your mouth and throat. For example, 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
- have difficulty swallowing
- you have changes in your voice
They will refer you to a lymphedema specialist if they think you may have lymphedema. It is important to start treatment early to stop the swelling from getting worse.
Exercises for lymphedema
If you have lymphoedema, your physiotherapist or specialist nurse will usually do these exercises with you. Using the muscles of the head, neck, and shoulders can help reduce swelling.
Below are 2 videos that can help you with these exercises. Both are from a physiotherapist called Carla from the lymphedema team at University College Hospital, London. Talk to your doctor or lymphedema specialist if you're not sure about doing any of these.
The first video shows you how to do breathing exercises. The second video shows you how to do head and neck exercises. It is important to do the breathing exercises before and after the head and neck exercises.
These exercises should not be painful, so you should stop them if you have pain. If the pain does not improve, contact your doctor. Do each exercise slowly and gently and it can help to rest in between.
The 1 minute deep breathing exercise video.
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Hi, I'm Carla, I'm going to show you how to do deep belly breathing. Remember to have good posture, relaxed shoulders. You can do them sitting or standing. Remember to inhale through the nose and exhale through the mouth.
So when you breathe in imagine you have a balloon in your belly and you are inflating that balloon and when you breathe out imagine you are deflating that balloon. You need to feel your hand going in, so we're going to do it together now. We will breathe…. outside too.
Remember to do them a maximum of five times before and after doing the lymphedema exercises.
Watch our videos on exercises for the area where you have lymphedema or are at risk of lymphedema.
The video on head and neck exercises is just under 3 minutes long.
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Hi, I'm Carla. I will show you how to do head and neck exercises. Remember to do the deep abdominal breathing exercises before and after. You will do each exercise 5 to 10 times and very important, without pain.
Neck exercises
We'll start with the head and neck. We will look to the side, back to the middle and the other side. It's normal to feel a bit of a stretch.
The next one will be ear to shoulder, not shoulder to ear. Return 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 will be the chin on the chest and the back in the starting position.
Shoulder exercises
Next will be the shoulders. We'll go up and relax and come down and relax.
Next will be circles. And we go back and then forward.
Oral exercises
We will also do mouth exercises. We'll start with the opening and closing. Blowing kisses, blowing candles, exaggerated smile. And then you exaggerate the vowels
Jaw exercises
And we will also do the jaw exercises. First we'll go side by side.
And then moving the jaw forward and back to normal.
Remember to do the deep abdominal breathing at the end, repeat them at least once a day, and if you have any concerns, just call your doctor or lymphedema specialist.
Find out more about lymphoedema on the Cancer Research UK website.
- Learn more about lymphedema
FAQs
Is lymph node in neck removal major surgery? ›
Neck dissection is a major surgery done to remove lymph nodes that may contain cancer. It is done in the hospital. Before surgery, you will receive general anesthesia. This will make you sleep and unable to feel pain.
What happens if neck lymph nodes are removed? ›The lymph nodes are part of your body's drainage system. Removing them can affect the natural circulation and drainage of tissue fluid. You should let your doctor or nurse know of any swelling you have.
Is removing lymph nodes a serious surgery? ›What are the side-effects of having lymph nodes removed? You're likely to feel sore and have some discomfort after your lymph node removal. There's a risk of complications such as infection and ongoing pain, too. You'll also have a long-term risk of lymphoedema– a build-up of lymph fluid.
How long does it take to recover from neck lymph node removal surgery? ›Neck lymph node dissection surgery is usually a 1 hour out-patient procedure, so the patient will be able to go home the same day as their surgery. Most patients will need about 1 week recovery time before they can return to work and normal activities.
What is the survival rate of lymph node surgery? ›Survival time and cumulative survival rates of different lymph node dissection groups. Among the 317 patients, the median survival time was 146.47 months. The 3, 5, and 10-year cumulative survival rates were 80.1%, 68.5%, and 54.6%, respectively.
How long is hospital stay after neck dissection? ›The length of time you're in the hospital after your surgery depends on your recovery. Most people stay in the hospital for 3 to 5 days.
What are the problems after having lymph nodes removed? ›Side effects of lymph node surgery. After lymph node surgery, pain, swelling, bleeding, blood clots, and infection are possible.
Is neck dissection high risk surgery? ›SURGICAL RISKS AND POSSIBLE COMPLICATIONS:
Despite neck dissection having many potentially serious risks, they occur very infrequently, and the surgical procedure is usually performed without difficulty. Most patients typically leave the hospital within two to five days after surgery.
Your lymph nodes play a vital role in your body's ability to fight off infections. Common areas where you might notice swollen lymph nodes include your neck, under your chin, in your armpits and in your groin.
How long does lymph node removal surgery take? ›General anesthesia is typically used for lymph node removal. This is typically an outpatient procedure, so the patient may be able to go home the same day. Many lymph node dissection surgeries take about an hour.
Why is lymph node surgery so painful? ›
The pain is usually caused by bruising, stretching or damage to nerves during surgery or when scar tissue forms. It seems to affect more people who have had surgery to the upper outer part of the breast and the armpit. These areas are particularly vulnerable to nerve injury.
How long are you in hospital after lymph node removal? ›Your surgeon will remove your lymph nodes under a general anaesthetic. You are likely to be in hospital overnight and may need to stay in for 3 to 5 days.
Why do they remove lymph nodes from the neck? ›The purpose of a neck dissection is to remove the lymph nodes in the neck. The surgery is almost always done for individuals with certain types of head and neck cancer.
Can you go home after lymph node removal? ›After the surgery, you may go home the same day. Or you may need to spend the night at the hospital. You will probably be able to go back to work or your normal routine in 3 to 6 weeks.
Is your immune system weaker after lymph node removal? ›While removing lymph nodes may increase survival rates and is a standard procedure, this process can also weaken your immune system. In some cases, lymph node removal can result in lymphedema, a condition in which the lymphatic system does not function properly, leading to compromised health (Fonfa).
Can I take care of myself after neck surgery? ›How Can I Take Care of Myself at Home? Please remember that it takes time for your neck and nerves to heal. You may have complete relief of your pain immediately after your surgery, but this is not normal. Allow yourself time to heal and do not do activities that may irritate your neck.
Can you live a normal life after neck surgery? ›Neck Surgery Benefits
After the procedure and recovery time, you'll be able to return to your normal life without having to think about pain every day.
- Ear numbness.
- Swallowing problems.
- Weakness when raising your arm above your head.
- Weakness in your lower lip.
- Wound healing problems.
Additional potential long-term problems include: Incision-Most incisions heal well, but some individuals develop scars. Numbness of the skin along the incision as well as over the cheek, ear and neck can be anticipated which improves with time; some long term numbness can be anticipated. Neck stiffness or pain.
Will I have a drain after lymph node removal? ›You will have two rubbery tubes (wound drains) in place which will help remove fluid from the wound after the operation.
How common is stroke after neck surgery? ›
During carotid endarterectomy, the risk has been reported to be between 0.9% and 3.6%. After a critical review of the literature, only 2 studies were found that addressed the incidence of perioperative stroke during head and neck surgery. They reported the risk of stroke during neck dissection to be 3.2% and 4.8%.
What is the success rate of neck dissection surgery? ›Recurrences at primary, regional and distant sites were demonstrated in 37 (28%), 11 (8%) and 3 (2%) of 131 patients who underwent neck dissection, respectively. The five-year overall survival (OS) was 67% for 131 patients: 80% for cN0, 68% for cN1 and 54% for cN2.
How do you sleep after a neck dissection? ›Head of Bed: Please elevate the head of your bed 30-45 degrees or sleep in a recliner at 30-45 degrees for the first 3-4 days to decrease swelling. The skin above the incision may look swollen after lying down for a few hours.
How long does neck dissection surgery take? ›The area for surgery is often marked to make sure there are no errors. You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery. The surgery will take about 2 to 4 hours.
What are the 7 levels of lymph nodes in the neck? ›Level I, submental (IA) and submandibular (IB); level II, upper internal jugular nodes; level III, middle jugular nodes; level IV, low jugular nodes; level V, posterior triangle nodes; level VI, central compartment; level VII, superior mediastinal nodes.
How many lymph nodes are on one side of the neck? ›Each side of the neck contains 20-100 lymph nodes. Lymph nodes, commonly referred to as "glands," are a part of the immune system. Lymph nodes act as a "filter" for conditions of the head and neck. They may enlarge in response to infection, inflammation, and tumors.
Can I drive after neck dissection? ›You should not lift >10 pounds for 3-4 weeks after surgery, this will cause pain and stretching at the surgery site and incision. You should not drive or drink alcohol while taking pain medications.
Does caffeine affect lymph nodes? ›Avoid diuretics (“water pills”), alcohol and caffeine.
They both could dilate the lymph tissue and cause more swelling, and as a result, exacerbate the lymphedema.
Avoid strenuous activities, such as biking, jogging, weightlifting, or aerobic exercise, until your doctor says it is okay. This includes housework, especially if you have to use your affected arm. You will probably be able to do your normal activities in 3 to 6 weeks.
What can you eat after a neck dissection? ›Avoid eating hard or scratchy foods like chips or raw vegetables. Avoid orange or tomato juice and other acidic foods that can sting the throat. If you cough right after drinking, try drinking thicker liquids, such as "smoothies." You may notice that your bowel movements are not regular right after your surgery.
How painful is a lymph node biopsy in the neck? ›
It shouldn't hurt. This will be the end of your test if your lymph nodes look normal. Any changes on the ultrasound need looking into further. If you need a biopsy, your doctor cleans your skin and may numb the area with local anaesthetic.
Are you more prone to infection after lymph node removal? ›In addition, there can be a long-term risk of infection if you had lymph node removal. Generally, the more lymph nodes and vessels removed, the higher the risk — and the risk doesn't go away after your incisions heal and cancer treatment ends.
How long are you at risk of lymphedema after lymph node removal? ›People who do develop lymphedema do so within two to three years after their surgery, but it is important to note that the risk remains over a person's lifetime and increases with trauma or injury to a limb. In some cases, these symptoms develop before swelling is noticeable.
Do you always get lymphedema after lymph node removal? ›It is estimated that as many as 30–50% of patients who undergo lymph node dissection go on to develop lymphedema2, 3. Lymphedema can even occur after less invasive procedures such as sentinel lymph node dissection thereby putting nearly all cancer survivors at risk for this dreaded complication4.
Is lymph node surgery major? ›Having lymph nodes removed can cause side effects. It is quite a big operation and can leave a large scar. It can also cause, or put you at higher risk of, lymphoedema. Lymphoedema is chronic swelling in an area near the area of surgery, usually an arm or leg.
How long does neck lump removal surgery take? ›Neck mass removal involves general anesthesia, typically for 1-2 hours. Patients may be quite sedated for several hours after surgery and may remain sleepy for much of the day.
What is a major neck surgery? ›The most common surgery for neck pain involves a discectomy, which is the removal of a problematic disc in the cervical spine. Typically, the surgery is performed through the front of the neck, called anterior cervical discectomy.
Is neck surgery very painful? ›It's normal to feel pain in and around the area of the surgery and numbness and tingling in the arms and shoulders. Patients may also experience difficulty swallowing as the procedure takes place in the neck. The first 1-3 months are critical in the recovery process as the bone graft is established.
Can you go home after neck surgery? ›Neck Surgery Process
While patients can usually go home within a few days after their surgery, recovery time is longer. Patients will have to adhere to rules that are put in place to keep them safe and to let the surgery heal.
What are the general indications for neck surgery? Nerve compression that leads to motor weakness. Nerve pain that is not tolerated or necessitates unacceptable reduction of activities due to pain. Degenerative disc or facet disease that causes intolerable neck pain.
What is the average age for neck surgery? ›
As long as you are physically and mentally healthy at the time of your treatment and are not dealing with any uncontrolled medical concerns such as bleeding disorders or hypertension, you should qualify. In general, it is most common for patients between 35 and 65 to pursue a neck lift.
What can you not do after neck surgery? ›Avoid excessive bending, twisting, pushing, pulling, or lifting anything more than 10 pounds for the first week. If you were fitted with a neck brace or soft collar, please wear it for most of the day when you are active for a total of 6 weeks.
Who is a candidate for neck surgery? ›The candidate needs to have reached full skeletal maturity (with no more bone growth left) but still be in good enough health for the procedure's benefits to outweigh the risks. Candidates for cervical ADR are typically between ages 20 and 70.