Lateral 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 next group of lymph nodes to be involved are the lateral neck nodes which are located around the major neck vessels. Some of these lymph nodes are the same ones that swell up when you have a throat infection. Diagram
If thyroid cancer reaches these lymph nodes, they need to be surgically removed. This requires extending the thyroidectomy incision around the side of the neck. The incision is significantly longer than that of a thyroidectomy but heals very well as it is maintained in the direction of your neck creases.
Removing these lymph nodes requires the dissection of and preservation of a number of major nerves including:
The Accessory nerve which controls the movement of neck and upper back muscles (shrugging of the shoulder)
The Vagus nerve which has multiple functions throughout the body but is also the nerve the gives rise to the recurrent laryngeal nerve (RLN) supplying the vocal cords.
The Phrenic nerve which moves the diaphragm muscle
The Hypoglossal nerve which controls some of the tongue muscles.
The cervical plexus nerves which give sensation to the neck and ear lobe.
Other structures that require careful dissection and preservation are the major lymphatic vessels at the base of the neck. Injury to these structures may result in a lymph leak. 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).
Following dissection of the lateral neck lymph nodes, a drain is placed and the skin is closed with dissolving sutures.
You will be admitted to hospital for 3-7 days depending on the output of the drain tube and whether or not a lymph leak occurs. If a lymph leak occurs, you will usually stay in hospital until this settles down which may take over a week.
- Although unlikely, injury may occur to any of the above-mentioned nerves with a loss of their function.
- Following a lateral neck dissection, 2% of patients may experience a lymph leak.
- This usually resolves without intervention but may require a low-fat diet and certain injections under the skin (Octreotide).
- If it does not settle, a radiological procedure called a lymphangiogram can be performed which usually stops the leak.
- Rarely, further neck surgery or even thoracic surgery to tie off the major lymphatic ducts may be required.
Take regular Panadol (as long as there are no medical reasons for you not to take it such as an allergic reaction or liver disease).
Non-steroidal anti-inflammatory medication such as Neurofen and Voltaren can also help with pain and inflammation but should be taken on a full stomach. Take these for the first 3-5 days as required.
Stronger pain killers such as opioid anaelgesics (Endone, Codeine) should be taken sparingly as they can cause constipation which results in more straining.
Once you are awake from the anaesthetic, you can have a normal diet as tolerated. You start with sips of water, clear fluids, then to a diet.
The drain stays in for as long as you are in hospital and is usually the main reason to keep you hospitalized. Once the drainage fluid is yellow in colour and only a small amount (<20mls) is draining every day, the drain will be removed.
Your wound is dressed with Steristrips only.
These are waterproof so you can shower but cannot swim or have a bath for 2 weeks or until after your follow up wound review.
Keep the Steristrips on for 1-2 weeks.
You should avoid straining for 1 week as this can increase the chance of post-operative bleeding.
You will be discharged once your drain is ready to be removed. This is usually between 3 and 7 days after surgery.
You will be seen 1-2 weeks after surgery for a wound check and to discuss your pathology results.
The appointment is usually made for you before leaving the hospital.