Surgery to remove the lymph nodes in your neck
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
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
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
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 lymph nodes from your neck, you are at risk of getting lymphoedema in your neck or face. 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 if you have:
- any swelling or a feeling of fullness or pressure
- find it difficult to swallow
- have changes in your voice
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
Swelling (lymphoedema)
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.
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.
This page is due for review. We will update this as soon as possible.
