Neck Dissection in Sharjah

What is a neck dissection?

A neck dissection is a cancer operation that removes groups of lymph nodes from the neck, together with the fatty tissue they sit in, in a single block. Lymph nodes are small filters along the lymph channels, and cancers of the mouth, throat, voice box, thyroid, salivary glands and facial skin often spread first to the nodes in the neck.

Surgeons map the neck into numbered levels, from level I under the chin and jaw down to level V at the back of the neck, with level VI in the centre in front of the windpipe. Each cancer tends to drain to predictable levels, so the operation is tailored to the cancer being treated:

| Type | What is removed |
|---|---|
| Selective neck dissection | Only the levels most at risk for that cancer |
| Modified radical neck dissection | All five side levels, keeping important nerves, muscle and vein |
| Radical neck dissection | All five side levels with the nerve, muscle and vein when cancer involves them |

A fact patients rarely expect: in most neck dissections today, the surgeon keeps the accessory nerve, which lifts the shoulder, the large neck muscle and the jugular vein, and removes only the nodes and fat around them. At Dar Al Kamal Hospital, Sharjah, neck dissection is performed in-house by the ENT and head and neck surgeon.

Who needs it

A neck dissection is recommended in two broad situations. The first is when cancer has already been found in a neck lymph node, usually after a neck lump assessment with ultrasound and a needle sample. The second is when there is a high chance of hidden spread that scans are too small to show, so the nodes most at risk are removed and examined.

Common reasons include:

• Cancer of the mouth, tongue, throat or voice box, often at the same operation as removal of the main tumour
• Thyroid cancer that has spread to neck nodes, alongside thyroid surgery
• Cancer of a salivary gland or of the skin of the face and scalp
• Nodes that remain enlarged after radiotherapy

Radiotherapy to the neck is an alternative for some cancers, and careful monitoring with repeat scans suits some small early cancers. The choice depends on the type and stage of the cancer, the scan and biopsy results, your general health and the treatment planned for the main tumour. The surgeon explains the extent of surgery proposed and whether radiotherapy or other treatment is likely to follow, and the decision is made with you.

What happens

Neck dissection is performed under general anaesthesia, so you are asleep throughout. The incision follows a natural skin crease in the neck, and for a wider dissection it curves to give the surgeon a full view while leaving a scar that lies in the lines of the neck.

The surgeon lifts the skin and the thin muscle beneath it, then removes the nodes and fatty tissue level by level. Along the way, each important structure is identified and protected: the accessory nerve to the shoulder, the small nerve branch to the lower lip, the nerve that moves the tongue, the nerve to the voice box, and the nerve to the diaphragm. A small drain is left under the skin to collect fluid, and the wound is closed with stitches or clips.

After a larger head and neck operation, a temporary tracheostomy is sometimes placed to protect breathing while swelling settles. You usually stay in hospital for several days while the drain is in place. The removed tissue goes to the laboratory, where each node is examined under the microscope.

Preparing for it

Before surgery you have scans of the neck and chest, the biopsy result is reviewed, and a pre-operative assessment and anaesthetic review confirm you are ready. A dental check is often advised, since radiotherapy may follow and healthy teeth matter for it. Bring a full list of your medicines; blood thinners and diabetes medicines each need a plan, and you receive clear fasting instructions.

Stopping smoking, shisha, midwakh and alcohol helps healing. Eating well before the operation builds reserves for recovery. Ask a family member to attend the planning appointment. If surgery falls near Ramadan, raise it early so fasting, medicines and nutrition can be planned around the operation.

Afterwards

The drain is removed once the fluid slows. Numbness of the skin of the neck and earlobe is common, because small skin nerves are divided during the operation, and feeling often returns gradually. Swelling under the chin and jaw is also common and settles slowly.

Shoulder exercises begin early to keep the joint moving, and physiotherapy supports shoulder strength where the accessory nerve was handled. Speech and swallowing therapists join the care when the main tumour operation involved the mouth or throat. Keep the wound clean and dry, and in the Sharjah sun protect the scar with clothing or sunscreen once it has healed. At follow-up the surgeon explains the laboratory findings, which guide whether further treatment is recommended, and sets up a schedule of regular checks.

Contact the hospital urgently if the wound becomes red, hot or swollen, if you have a fever, or if milky fluid leaks from the wound or drain site. **Go to the emergency department straight away if the neck swells quickly or you have difficulty breathing or swallowing.**

Cost and insurance

Most UAE insurance plans cover neck dissection as part of cancer treatment, with pre-approval required and supported by the biopsy report and staging scans. Radiotherapy or other treatment that follows is usually approved separately. Dar Al Kamal Hospital, Sharjah can help you confirm your cover on 06 599 7777.