Block Dissection of the Neck

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Overview

Block dissection of the neck is a surgical procedure to remove complete groups of lymph nodes from the neck. This is typically performed in case of infected or cancerous lymph nodes.

The lymph nodes help produce white blood cells called lymphocytes that help the body fight infections and diseases. Sometimes, the lymph nodes may get infected or cancerous cells in the mouth or throat may metastasize to the lymph nodes.  

Block dissection of the neck is usually opted when all other approaches have failed to remove the cancerous tissues or to prevent cancer from spreading to other parts of the body. Block neck dissection is a different surgery than plucking out a few nodes from the neck.  

Levels of Block Neck Dissection

The breadth of the block targeted for neck dissection will depend on a number of factors. Most important factor is the site of the primary cancer. The level will be decided on the basis of metastasis and primary location of the cancer. The following are the levels of block neck dissection:

  • Level I, II, III: For oral cavity
  • Level II, III, IV: For oropharynx, hypopharynx and larynx
  • Level V: For scalp and facial skin
  • Level VI: For thyroid and larynx
  • Level VII: For thyroid

Types of Block Neck Dissection

Block neck dissection are of several types, depending on the targeted level. The following are some of the common types of block neck dissection.

Radical neck dissection: This procedure refers to the elimination of lymph nodes Level I to V. All the tissue on the side of the neck from the jawbone to the collarbone, as well as the muscle, nerve, salivary gland and major blood vessels in this area are removed during this procedure.

In some cases, extended radical neck dissection is also used, which includes removal of all of these, plus additional lymph node groups or non-lymphatic structures.

Modified radical neck dissection: This is the most common type of block neck dissection. This procedure also includes removal of Level I to V, while sparing sternocleidomastoid muscle, internal jugular vein and spinal accessory nerve or any one of these three structures, which are usually taken in the radical neck dissection. A modified radical neck dissection that preserves all the three structures is also called as comprehensive neck dissection.

Selective neck dissection: In this procedure, selected group of lymph nodes are removed, if the cancer has not spread far. The most favorable benefit of this procedure is that the muscle, nerve, and blood vessel in the neck may also be saved.

Some common selective block neck dissections are named as:

  • Supraomohyoid neck dissection: In this procedure I, II and III levels are removed.
  • Lateral neck dissection: This is the removal of lymph node level II, III and IV.
  • Posterolateral neck dissection: This is the removal of lymph node level II, III, IV and V.

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Before the Treatment

Before Block Neck Dissection Surgery

 

Your doctor will choose the best neck dissection procedure for you depending on your targeted area. Your doctor will examine your medical condition and your overall health. Do not forget to discuss all the medicines vitamins, herbs, and supplements you are taking, including those you take without a prescription. You might be asked to stop any specific medicines, including aspirin, ibuprofen, naproxen, warfarin and other blood thinning medicines.

On the day of your surgery, you will be asked not to drink or eat anything after midnight prior to surgery. You should take only prescribed medicines with a small sip of water.

How it is Performed

How is it performed?

During the surgery, you will be first administered anesthesia so that you remain completely unconscious during the entire procedure. The surgeon will then make an incision, the size and location of which may depend upon the desired outcome in terms of reduction in cancer risk and systematic removal of the lymph nodes.

This is only possible by identifying and preserving all the major structures in the neck while ensuring effective removal of lymph nodes. In a few cases, some major structures such as sternocleidomastoid muscle, the internal jugular vein and the spinal accessory nerve, might need to be removed because of the presence of aggressive cancer.

After the removal of targeted level, your surgeon will probably place a small drainage to drain any blood or fluid that might accumulate in the space that is created by removing the lymph nodes. This drain will be removed after one or two days and takes only a few seconds for removal.

Recovery

Recovery

After the surgery, you will be taken to the recovery room. You have to stay there until you wake up, then you will be shifted in your room. Mostly, patients are able to get out of bed by the next day and they can slowly drink liquids and eat as well.

You might get discharged from the hospital in 2 to 3 days. However, you will need to visit your doctor for a follow-up visit in 7 to 10 days after block neck dissection surgery.

Pros:

  • Damage to nerves and tissues can be prevented

Cons:

  • Side effects such as swelling, shoulder pain and general pain may appearance
  • Loss of feeling and taste

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Block Dissection of the Neck

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