Definition

Functional neck dissection involves the removal of cancerous glands of the neck but keeping important structures of the neck.

Indications

The reason for a functional neck dissection is to remove cancerous lymph glands in the neck. Lymph glands are found throughout the body and contain lymph cells, which are used to fight infection and kill cancer cells. If a cancer grows in the mouth or throat it can spread to the lymph glands in the neck. Usually the lymph glands kill the cancer cells and act as a barrier for further spread. Unfortunately these glands can become overwhelmed and no longer act as barriers. When this occurs the glands grow in size and if left untreated may spread to the rest of the body or grow into important vessels and nerves.

It has been found that one way to deal with these enlarged glands is to cut them out in a very special manner: a neck dissection. If the glands are small (less than 3 centimetres), have not invaded nearby structures and the patient has not had radiotherapy then a special type of neck dissection can be done: a "functional neck dissection". The advantage of this type of surgery is that it does very little harm to the patient, as important neck structures are not removed with the neck glands. It also has the benefit of telling the cancer team if there is any cancer cells present in the glands, as the cause of enlarged glands in a ¼ of patients is infection only. This means that some patients may not require radiotherapy.

The cancer team managing this condition must be experienced and one way to find this out is to ask how many "new head & neck cancers" they treat every year. If they see at least 80 patients a year then they are probably experienced enough. In addition the cancer team should be composed of an Ear, Nose & Throat Surgeon, an Oral-Maxillo-Facial Surgeon, a Plastic & Reconstructive surgeon, a Clinical Oncologist, a Head & Neck Nurse and Head & Neck Dietician. All members of the team should be present at the meeting with you.

Anaesthetic

The operation is always performed when the patient is asleep (under general anaesthetic)

Technique

The aim of the procedure is to remove the lymph glands on that side of the neck but spare the important structures in the neck. The most important to try to preserve is the nerve which supplies a muscle called the trapezius. This is the "shrug" muscle and if the nerve is cut to this muscle then it will not work. The effect of this can be a painful stiff shoulder.

Length of Operation

The operation is usually only about 2 hours but may be longer if it is combined with a neck dissection on the other side and an operation on the mouth or throat.

Time in Hospital

The patient stays about 3 to 4 days in hospital after the operation

Time Off Work (Limitations)

This will vary according to nature of work. This should be discussed with the cancer team.

Risks & Complications

Bleeding - This is usually a problem in the first 24 hours leading to a collection of blood or haematoma. Blockage of the neck drains may be responsible. The haematoma is normally removed under a general anaesthetic.

Chylous fistula - Damage to the lymphatic duct in the base of the neck will result in leakage of milky bile into the neck. Once feeding commences the discharge into the drains becomes milky in colour. The fistula may close spontaneously although surgical closure is normally recommended due to thelarge amount of protein that can be lost.

Infection - Short term antibiotic usage has decreased this problem. Most infections occur due to contamination by saliva. Drainage and antibiotics normally solve the problem.

Carotid artery rupture - This is the most dangerous complication and is associated with preoperativ The information was not saved correctly.