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Neck Dissection Surgery at Johns Hopkins

A neck dissection in a patient with thyroid cancer (papillary and medullary) is performed for several reasons. The purpose of a neck dissection surgery is to remove all lymph nodes for local disease control. You will be in the hospital usually one or two nights depending on whether you have a unilateral (one side) or bilateral (both sides) neck dissection. Sometimes a neck dissection is also performed in conjunction with a total thyroidectomy.

As with any surgical procedure, there are risks involved. There is a risk of bleeding, but this is very low. The average blood loss is less than an ounce. The risk of infection is also low enough that antibiotics are not routinely used. There is also a very low risk of injury to important nerves such as the recurrent laryngeal nerves in the neck which control the vocal cords. Injury to these nerves could affect your voice. Other nerves at risk include the spinal accessory nerve injury affecting the shoulder muscles; phrenic nerve injury resulting in diaphragmatic paralysis, injury to the symphatetic ganglion resulting in Horner’s syndrome ( affecting the pupillary reflex and eyelid ) and numbness to the shoulder and ear due to sensory loss in the skin. The parathyroid glands are located near the thyroid gland and may be injured during a neck dissection and thyroid surgery. This can result in a drop in blood calcium levels. There is also a small risk associated with anesthesia. However, the relative risk of complications is low and is usually outweighed by the potential benefits of having the surgery. Your surgeon will go over this information with you and answer any questions you might have.

Before Surgery

Once the surgery has been scheduled, arrangements will be made for your pre-operative evaluation. You will meet with a nurse practitioner or physician’s assistant from the anesthesiology department. The pre-op exam can include laboratory work, chest X-ray, and EKG. This will be done at the Johns Hopkins Outpatient Center and will be scheduled by your surgeon’s secretary. 

If you take aspirin, nonsteroidal anti-inflammatory agents or any blood thinning agents, you should stop taking these 10 days before surgery. The night before surgery, do not have anything to eat or drink after midnight. The practitioner in pre-operative evaluation will instruct you if there are certain medications that you need to take on the morning of surgery. Get a good night’s sleep.

The Day of Surgery

Your doctor’s secretary will let you know where your surgery will be and what time you need to arrive at the hospital on the day of surgery. It is very important to arrive at least 2 hours before surgery. During the surgery, your family can wait in the family waiting area. They will be kept updated by the patient representative and operating room staff. The surgeon will speak with them after surgery has been completed.

What will happen in surgery?

You will be given general anesthesia to put you to sleep. You are positioned with special pillows under your neck to tilt your head back. If you are also having a thyroidectomy, an incision is made at the base of your neck and is about three to four inches long. For the neck dissection an incision is made along the side of the neck. Using magnifying lenses, the surgeon locates the thyroid gland, lymph nodes and associated structures and the thyroid and lymph nodes on the affected side are removed. The incision is stitched closed and is then covered with steri-strip tapes and a dry gauze dressing. The operation can last several hours. After surgery, you will stay in the recovery room for several hours as you recover from the anesthesia or be monitored in the intensive care unit overnight.

After Surgery

The evening after surgery you may have a liquid diet for dinner. You may have a sore throat. You will provided lozenges and/or throat spray to help relieve this. You will also be given liquid pain medicine. You will have a dressing on your neck which will be removed in the morning. You will have one to two drains which may be removed before you are discharged. The head of your bed will be raised to decrease swelling. You will have an intravenous line to give you fluids until the next day. You will have routine blood tests. You will be offered regular food the next morning. Most people are ready to go home by early afternoon on the following day.

The Incision

After the dressing is removed, you will notice that the incision is covered with tapes (steri-strips). These should stay in place till your follow up visit. You may shower and wash your hair the day after surgery. Try to keep the neck area as dry as possible and pat dry after showering. The stitches will be removed in the office about a week and a half after surgery. Infection is extremely rare. If you notice any redness or drainage from the incision contact your surgeon. After the stitches are removed, the most important thing you can do to improve the appearance of your scar is to protect it with sunscreen that has a sun protection factor (SPF) of 30 or keep it covered from the sun for an entire year. During the year your scar may become raised or red, but will almost always fade into a thin line which will be less noticeable.

How will I feel after surgery?

Everyone is different. You will most likely be tired and a bit sore for a few days. You may have pain not only from your incision, but also from muscle soreness in your upper back and shoulders. This is from the positioning in the operating room during the surgery. You will have liquid pain medicine in the hospital and a prescription for pain pills at home.

You may have a sore throat. This is a result of the placement of anesthesia tubes during surgery. Throat lozenges and spray usually help. Your neck may be slightly swollen as well. You may feel like you have a lump in your throat when you swallow. This will improve after a few days but may continue for a week or so. If you notice sudden swelling in your neck along your incision, contact your surgeon’s office. This may be due to a hematoma (bleeding) or a seroma (body fluid collection). Your calcium level may drop after surgery, especially if you have also had a thyroidectomy. This is related to disturbance of the parathyroid gland, which regulates calcium balance. This will be monitored through blood tests. You may notice numbness and tingling of your fingers or around your mouth. You will have instructions about taking calcium replacement if needed.

Recovering at Home

Most people take 2 to 4 weeks off to recover. You should not drive until the stitches have been removed and while on narcotic pain medication. There are no other restrictions. You will be placed on thyroid hormone following your surgery.

 

 

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