Cancers of the mouth and oropharynx can spread to lymph nodes in your neck.
Why you need surgery to remove the lymph nodes
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.
Before your operation, your surgeon might know there is cancer in your lymph nodes. In this case, you have a neck dissection during your surgery 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 will suggest removing the lymph nodes closest to the cancer. They send the nodes to the laboratory to check them for cancer cells.
If there is cancer in the lymph nodes you might need to have more surgery to remove more nodes. Or you may have radiotherapy to that area.
There are different types of neck dissection:
- selective neck dissection
- modified radical neck dissection
- radical neck dissection
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 different types of modified radical neck dissection.
Your surgeon may just remove most of the lymph nodes between your jawbone and collarbone on one side of your neck.
Or they may also remove one or more of the following:
- 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 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
Side effects of neck dissection
These operations are important for getting the best chance of stopping the cancer from spreading or coming back. But there are some side effects. These depend on which of the following nerves or muscles have to be removed.
The accessory nerve controls shoulder movement. So if you have it removed, your shoulder becomes stiffer and more difficult to move. Raising your arm over your head on that side can also become more difficult.
After a selective neck dissection, the weakness in your arm is usually temporary.
But if the surgeon completely removes your accessory nerve, the damage is permanent. Usually you see a physiotherapist, who teaches you exercises to help improve the 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, a referral to a shoulder surgery specialist may be considered.
Removing all of your sternocleidomastoid muscle doesn't usually cause a problem. But it does make your neck look thinner and sunken on that side.
After a neck dissection on both sides in which both of these muscles are removed, you do have some difficulty bending your head forward. Physiotherapy can help to improve movement and prevent stiffness.
Cranial and spinal nerves
The cranial and spinal nerves supply the head and neck area. A neck dissection can damage some of these nerves. If this happens you might 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 feeling on one side of the tongue
After surgery, the area can be swollen. This should go down within a few weeks. If you have had lymph nodes removed, there is a risk of developing swelling later on. This swelling is called lymphoedema (limf-o-dee-ma).
The lymph nodes are part of your body's drainage system. Removing them can affect the natural circulation and drainage of tissue fluid in this area. Lymphoedema in the head or neck can also cause symptoms inside your mouth and throat. For example, swelling of your tongue and other parts of your mouth.
Tell your doctor if you:
- have any swelling or a feeling of fullness or pressure
- find it difficult to swallow
- have changes in your voice
Exercises for lymphoedema
If you have lymphoedema, your physiotherapist or specialist nurse will usually go through these exercises with you. Using your head, neck and shoulder muscles may help to reduce swelling.
Below are 2 videos that can help you with these exercises. Both are by a physiotherapist called Carla from the lymphoedema team at University College Hospital London. Speak to your doctor or lymphoedema specialist if you are unsure about doing any of them.
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 must stop them if you have any pain. If the pain doesn't get better contact your doctor. Do each exercise slowly and gently, and it may help to rest in between.
The video about deep breathing exercises is 1 minute long.
Hi I’m Carla, I’m going to show you how to do deep abdominal breathing. Remember to have a nice posture, relaxed shoulders. You can do them sitting down or standing up. Remember to breathe in by nose and breathe out by mouth.
So, when you breathe in, imagine you have a balloon in your tummy and you inflate this balloon and when you breathe out, imagine you’re deflating this balloon. You need to feel your hand going in so we’ll do it together now. We’ll breathe in…. and out.
Remember to do them a maximum five times and before and after you do your lymphoedema exercises.
Watch our videos for the exercises of the area where you have lymphoedema or you’re at risk of lymphoedema.
The video about head and neck exercises is just under 3 minutes long.
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.
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.
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.
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
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.