Neck Lymph Node Removal

Introduction

The lymphatic system, comprised of lymph nodes and lymph vessels, is a major component of the body’s immune system.

Lymph nodes are small glands present throughout the body that contain immune cells to help fight infection. The lymph nodes enlarge in the presence of infection, inflammation, or cancer.

Surgery to remove enlarged lymph nodes is called lymph node dissection. Cervical lymph node dissection is performed to remove cancerous lymph nodes in the neck (cervical region).

Disease Overview

The cervical lymph nodes are located in the fibrous fatty tissue layer that surrounds the neck. They are grouped around certain neural and vascular structures. Cervical lymph nodes are classified into different groups depending on their anatomical region.

Cancers of the head and neck commonly metastasize or spread via the lymphatic route. The cancerous cells collect in the lymph nodes of the neck where they multiply and grow.

The affected lymph nodes may be enlarged or feel abnormal when touched. Sometimes cancer cells may be present in the lymph nodes but cannot be detected by physical examination or imaging studies. Lymph node groups at risk for metastatic disease can usually be predicted by the size, location, and other characteristics of the primary tumor. If there is a high likelihood of metastasis to a particular lymph node group your doctor will recommend removing that group to eliminate the cancer.

Indications

Cervical lymph node dissection is performed as part of the surgical treatment for head and neck cancers such as those of the skin, oral cavity, pharynx and throat.

Surgical procedure

The aim of the procedure is to prevent cancer from spreading to other parts of the body.

The procedure is performed under general anesthesia. You are placed on your back in the supine position with the neck extended. An endotracheal tube is placed to protect your airway.

Your surgeon makes an incision in the muscle at the front of the neck (platysma, under the chin. The type and location of the incision depends on the group of lymph nodes to be removed. A flap of tissue is then raised. Care is taken to avoid damage to important blood vessels and nerves.

The cervical lymph nodes can be removed by radical lymph node dissection which involves removal of the lymph nodes on the affected side of the neck along with certain non-lymphatic structures such as the sternocleidomastoid muscle, the spinal accessory nerve and the internal jugular vein. Depending on the type and location of the primary cancer and the extent of metastatic spread, your surgeon may modify this approach. Once the lymph nodes are removed, the incision is closed with sutures or staples.

Post-Operative Care

Following the procedure, you will be taken to the recovery room and monitored carefully. You will have a drain tube coming from the incision which was placed during surgery to allow drainage and prevent any fluid accumulation. Your doctor will prescribe medications to help alleviate pain and discomfort. You will begin on a liquid diet the day after surgery and will progress to solid foods as tolerated. The sutures are usually removed 7-10 days after surgery. Before leaving the hospital, you will be taught how to care for your incision.