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Surgery to remove the lymph nodes in your neck

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.

Diagram showing the lymph nodes in the head and neck

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

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
Diagram showing the muscle, nerve and blood vessel sometimes removed with a lymph node dissection of the neck

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

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.

Accessory nerve

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.

Sternocleidomastoid muscle

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

Swelling (lymphoedema)

When you have surgery to remove lymph nodes from your neck, you are at risk of getting swelling. This is called lymphoedema and happens in your neck or face.

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

Tell your doctor if you:

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

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.