Central Neck Dissection
Thyroid cancer may spread to the lymph nodes in the neck. To understand what this means, you need to understand what lymphatic fluid is. The heart pumps blood to the rest of the body (including the thyroid) through arteries. Most of the fluid in the blood returns to the heart through veins. A small amount of fluid stays in the tissues (including the thyroid) and returns to the heart through small clear channels called lymphatics. This lymphatic fluid goes through a series of lymph nodes to be screened for infection.
If thyroid cancer cells reach the lymphatics, they can be trapped by the neck lymph nodes. The first group of lymph nodes that trap cancer cells from the thyroid are central neck nodes. These are the nodes located in the centre of the neck below and immediately next to the thyroid gland.
The lymph nodes on the cancer side between the trachea (windpipe) and the major blood vessels of the neck are removed taking care not to injure the recurrent laryngeal nerve (RLN). No extra incision is required to reach these lymph nodes. They are removed through the same incision as the thyroidectomy.
- The risk of nerve injury increases due to the more extensive dissection of the nerve.
- Central neck dissection results in the loss of blood supply to the lower parathyroid gland. If the lower parathyroid gland is easily seen, it is removed and injected into one of the neck muscles (autotransplant). It may not be easily recognized and thus may be removed with the central neck nodes.
- Rarely, a lymph leak may occur following a central neck dissection. This is where the lymphatic vessels may be damaged and leak lymph fluid into the neck.
- It can present as a neck swelling but is more commonly seen as milky fluid in the drain tube. It usually resolves without intervention but may require a low-fat diet and certain injections under the skin (Octreotide).
A central neck dissection is usually done in conjunction with a thyroidectomy. Please see thyroidectomy information for what to expect before and after your surgery.