Postoperative Instructions for Neck Node and Neck Dissection
Lymph Nodes: Each side of your neck has more than 20 lymph nodes. These nodes drain fluid from the face, mouth, and throat. The nodes may be enlarged due to infections (viral or bacterial) or nests of cancer cells (metastases).
Neck Dissection: The purpose of a neck dissection is to remove the lymph nodes at most risk for the presence of cancer cells. Head and neck cancers spread to nodes in a fairly predictable pattern. This pattern allows the surgeon to fairly reliably remove the nodes at most risk for cancer cells by dissecting the tissues in specific areas of the neck and spare other areas of the neck from the surgery. Some patients have CT scans done prior to help plan the surgery.
The neck dissection starts with an incision through the skin, the exact location varies from patient to patient, you may ask your surgeon to illustrate the planned incision. Next the fat and lymph nodes in the desired areas are removed. The surgeon attempts to spare as much normal tissue as possible, but cancer cells do not respect tissue boundaries and frequently invade other healthy tissue. Some structures that are commonly removed are the internal jugular vein (IJ), the sternocleomastoid muscle (SCM), and the spinal accessory nerve (XI). There are usually little noticeable effects from removing one IJ. The SCM runs from behind your ear down to your collarbone and helps turn your head left and right. The spinal accessory nerve controls the SCM and the muscles that help shrug your shoulder. If part of the SCM is removed, it may be painful to raise your head off the pillow for several days; you may place your hand behind your head when sitting up during this healing time. Your neck may appear thinner on the side that the SCM is removed. If part of the spinal accessory nerve is cut, you may notice trouble raising your shoulder or raising your outstretched arm sideways above horizontal. Ask your surgeon about daily exercises to maintain good shoulder mobility. Some patients see a physical therapist to learn these exercises. The greater auricular nerve runs right across the incision and often must be cut for access to deeper tissues. If the nerve is cut, the area around the earlobe will be numb.
Incision: Please keep the incision dry for 2-3 days, and then gently wash the incision with soap and water 2-3 times a day as needed. You may use Q-tips dipped in peroxide to remove any dried blood over the incision. After washing, please apply a thin film of an antibacterial ointment (e.g. Polysporin). Please avoid any activity that pulls across the incision such as shaving across the incision for at least 2 weeks. (The rest of the face may be shaved.) The staples and stitches will be removed 1-2 weeks after surgery
Drain: Some patients are discharged with a thin drain tube and oval collecting reservoir called a grenade. When the grenade looks half full or at least 2 times a day, please record the amount of fluid and then empty the grenade. Discard the fluid in the sink or toilet.
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. Elevating the head is crucial when both sides of the neck have been dissected to avoid a “swollen, puffy face”.
Activity: Please avoid any activity that raises your blood pressure for one week, e.g. heavy lifting, strenuous exercise, etc.
Diet: You may eat your regular diet after surgery. If the oral “pucker” muscles are weak, you may drool slightly when drinking or have trouble with very sticky foods like peanut butter. You may notice a slight increase in fluid from your incision while eating; this is normal and usually resolves by a few weeks.
Shoulder exercises: May be started in the first week after surgery. Try to raise both arms out sideways and hold steady for several seconds. You may use small weights if desired. A physical therapist can help with your instruction.
Pain: Pain can be mild to moderate the first 24 – 48 hours, but usually declines thereafter. The sooner you reduce your narcotic medication use, the more rapid your recovery. As your pain lessens, try using extra-strength acetaminophen (Tylenol) instead of your narcotic medication.
Pain Management: A realistic goal is to reduce the patient’s pain to a manageable level, and not to eliminate the pain. One cannot predict either a patient’s pain level or the necessary dose of pain medicine in all patients. One must approach each patient in a stepwise fashion for pain management. Specifically, please start at an intermediate dose of narcotic, and increase the dose if pain remains uncontrolled, or decrease the dose if the medications’ side effects are too severe. Close monitoring of the patient for side effects of each medication is essential.
Other Questions: For non-emergent questions, please call our office, 503-581-1567, between 9:00 am and 3:00 pm Monday through Friday. For emergent questions, call our office and our answering service will page the doctor on call. We have a doctor on call 7 days a week.