This guide will help you get ready for your neck dissection surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery. Show
Use this guide as a source of information in the days leading up to your surgery. Bring it with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care. Back to topAbout Your SurgeryHead and neck cancer can spread to your lymph nodes. Lymph nodes are small oval or round glands along your lymphatic system. To make them easier to describe, the lymph nodes in your neck are divided into 5 levels (see Figure 1). The 5 levels are labeled using Roman numerals (I, II, III, IV, and V). You may have a neck dissection if there is a high risk of the cancer spreading to the lymph nodes in your neck. This is a surgery to remove the lymph nodes in your neck area. There are several types of neck dissections. The type you’ll have depends on the cancer’s location, and if it spread to your lymph nodes or to other structures in your neck. Sometimes your surgeon can tell which lymph nodes are affected by examining you. If this isn’t possible, you may need to have a computed tomography (CT) scan or ultrasound of your neck so your surgeon can see the area better.  Figure 1. Levels of lymph nodes In addition to the lymph nodes, other structures in your neck may need to be removed, including:
Getting Ready for Your SurgeryThis section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready. As you read through this section, write down questions to ask your healthcare provider. Getting Ready for SurgeryYou and your care team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you’re not sure.
About Drinking AlcoholThe amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
Here are things you can do before your surgery to keep from having problems:
About SmokingIf you smoke, you can have breathing problems when you have surgery. Stopping for even a few days before your surgery can help. Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling 212-610-0507. About Sleep ApneaSleep apnea is a common breathing problem. It causes you to stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep. OSA can cause serious problems during and after a procedure. Please tell us if you have or think you might have sleep apnea. If you use a breathing device (such as a CPAP machine), bring it on the day of your procedure. Within 30 days of your surgeryPresurgical Testing (PST)You’ll have a PST appointment before your surgery. The date, time, and location will be printed on the appointment reminder from your surgeon’s office. You can eat and take your usual medications the day of your appointment. It’s helpful to bring these things to your appointment:
During your PST appointment, you’ll meet with a nurse practitioner (NP). They work closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests to plan your care. Examples are:
Your NP may recommend you see other healthcare providers. They’ll also talk with you about which medications to take the morning of your surgery. Identify Your CaregiverYour caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged from the hospital. They’ll also help you care for yourself at home. For Caregivers Caring for a person going through cancer treatment comes with many responsibilities. MSK offers resources and support to help you manage them. For information, visit www.mskcc.org/caregivers or read A Guide for Caregivers. Complete a Health Care Proxy FormIf you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment. A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.
Do breathing and coughing exercisesPractice taking deep breaths and coughing before your surgery. Your healthcare provider will give you an incentive spirometer to help expand your lungs. For more information, read How To Use Your Incentive Spirometer. If you have any questions, ask your healthcare provider. ExerciseExercising will help your body get into its best condition for your surgery and make your recovery faster and easier. Try to do aerobic exercise every day. Aerobic exercise is any exercise that makes your heart beat faster, such as walking, swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping center. Follow a Healthy DietFollow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist. 7 days before your surgeryFollow Your Healthcare Provider’s Instructions for Taking AspirinIf you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding. Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to. For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E. Stop Taking Vitamin E, Multivitamins, Herbal Remedies, and Other Dietary SupplementsStop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. If your healthcare provider gives you other instructions, follow those instead. For more information, read Herbal Remedies and Cancer Treatment. 2 days before your surgeryStop Taking Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)Stop taking NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), 2 days before your surgery. NSAIDs can cause bleeding. If your healthcare provider gives you other instructions, follow those instead. For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E. 1 day before your surgeryNote the Time of Your SurgeryA staff member from the Admitting Office will call you after 2 p.m. the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by 7 p.m., call 212-639-5014. The staff member will tell you what time to arrive at the hospital for your surgery. They’ll also remind you where to go. This will be one of the following locations:
SleepGo to bed early and get a full night’s sleep. Instructions for Eating Before Your Surgery The morning of your surgeryInstructions for Drinking Before Your Surgery You can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else. Do not drink anything starting 2 hours before your scheduled arrival time. This includes water. Take Your Medications As InstructedA member of your care team will tell you which medications to take the morning of your surgery. Take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications. Things to remember
What to bring
Where To Park
MSK’s parking garage is on East 66th Street between York and 1st venues. If you have questions about prices, call 212-639-2338. To reach the garage, turn onto East 66th Street from York Avenue. The garage is about a quarter of a block in from York Avenue. It’s on the right (north) side of the street. There’s a tunnel you can walk through that connects the garage to the hospital. There are other parking garages located on:
Once you’re in the hospitalYou’ll be asked to say and spell your name and birth date many times. This is for your safety. People with the same or a similar name may be having surgery on the same day. When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear. Meet With a NurseYou’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight and the time you took them. Make sure to include prescription and over-the-counter medications, patches, and creams. Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist will do it in the operating room. Meet With an AnesthesiologistYou’ll also meet with an anesthesiologist before surgery. They will:
Get Ready For Your SurgeryWhen it’s time for your surgery, you’ll need to remove your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles. You’ll either walk into the operating room or a staff member will bring you there a stretcher. A member of the operating room team will help you onto the operating bed. They’ll place compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs. Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery. During your surgeryOnce your surgery is finished, your incision will be closed with staples or sutures (stitches). You may also have Steri-Strips™ (thin pieces of surgical tape) or Dermabond® (surgical glue) over your incisions. Your incisions may be covered with a bandage. Back to topRecovering After Your SurgeryThis section will help you know what to expect after your surgery. You’ll learn how to safely recover from your surgery both in the hospital and at home. As you read through this section, write down questions to ask your healthcare provider. What to expectWhen you wake up after your surgery, you’ll be in the Post Anesthesia Care Unit (PACU). A nurse will be keeping track of your body temperature, pulse, blood pressure, and oxygen levels. You may be getting oxygen through a thin tube that rests below your nose or a mask that covers your nose and mouth. You’ll also have compression boots on your lower legs. Pain medicationYou’ll have some pain after your surgery. At first, you’ll get your pain medication through your IV line. Once you’re able to follow a regular diet, you’ll get oral pain medication (medication you swallow). Tubes and drainsDepending on the amount of lymph nodes removed, you may have a ReliaVac® (see Figure 2) or Jackson-Pratt® (see Figure 3) drain placed in your neck. This will drain fluid from around your incision and keep fluid from collecting under your skin. The drain doesn’t hurt. Your healthcare providers will empty it regularly.
Figure 2. ReliaVac® drain in your neck Figure 3. Jackson-Pratt® drain Moving to your hospital roomDepending on the type of surgery you had, you may stay in the PACU overnight. After your stay in the PACU, a staff member will take you to your hospital room. In your hospital roomThe length of time you’re in the hospital after your surgery depends on your recovery. Most people stay in the hospital for 3 to 5 days. When you’re taken to your hospital room, you’ll meet one of the nurses who will care for you while you’re in the hospital. Soon after you arrive in your room, your nurse will help you out of bed and into your chair. While you’re in the hospital, your healthcare providers will teach you how to care for yourself while you’re recovering from your surgery. Managing your painYou’ll have some pain after your surgery. At first, you’ll get your pain medication through your IV line. Once you’re able to eat, you’ll get oral pain medication (medication you swallow). If you also had surgery in your oral cavity or a free flap surgery, you’ll be able to control your pain medication using a PCA device. Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell one of your healthcare providers. It’s important to control your pain so you can use your incentive spirometer and move around. Controlling your pain will help you recover better. You’ll get a prescription for pain medication before you leave the hospital. Talk with your healthcare provider about possible side effects and when to start switching to over-the-counter pain medications. Moving around and walkingMoving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements (pooping) again. Your nurse, physical therapist, or occupational therapist will help you move around, if needed. Read the resource Call! Don't Fall! to learn what you can do to stay safe and keep from falling while you’re in the hospital. Exercising your lungsIt’s important to exercise your lungs so they expand fully. This helps prevent pneumonia.
Eating and drinkingFor your first meal after your surgery, you’ll have only clear liquids. After that, you’ll slowly start eating solid food. If you have questions about your diet, ask to see a clinical dietitian nutritionist. Caring for your tubes and drainsYour healthcare provider will remove your ReliaVac or Jackson-Pratt drain when the amount of drainage is steadily decreasing to less than 25 to 30 milliliters (about 1 ounce) in 24 hours. This is usually 3 to 5 days after surgery. Some people may go home with the drain in place. If this is the case, your nurse will teach you how to care for it before you leave the hospital. For more information, read the resources Caring for Your ReliaVac Drain or . It’s helpful if your caregiver also learns how to care for your ReliaVac or Jackson-Pratt drain. This will make it easier for them to help you care for yourself if you have to go home with it. Removing staples and suturesIf you stay in the hospital for longer than 1 week, your healthcare provider will remove some or all of your staples or sutures before you leave. If you stay in the hospital for less than 1 week, your healthcare provider will remove your staples or sutures during your first appointment after surgery. If you go home with Steri-Strips, they’ll loosen and fall off or peel off by themselves. If they are still on during your first appointment after surgery, your healthcare provider will remove them. If you had radiation therapy to the neck before your surgery, your staples or sutures may stay in place for 2 to 3 weeks. ShoweringYou can shower 24 hours after your drain is removed from your neck. Remove the bandage that was placed. When showering, don’t let the water from your shower head hit your incision directly. Rather, allow the soap and water to run over your incision. Don’t rub the area around your incision. After you shower, pat the area dry with a clean towel. If you still have drainage tubes in, don’t shower until your healthcare provider removes your drain. At homeRead the resource What You Can Do to Avoid Falling to learn what you can do to stay safe and keep from falling at home and during your appointments at MSK. Filling out your Recovery TrackerWe want to know how you’re feeling after you leave the hospital. To help us continue caring for you, we’ll send questions to your MyMSK account every day for 10 days after you leave the hospital. These questions are known as your Recovery Tracker. Fill out your Recovery Tracker every day before midnight (12 a.m.). It only takes 2 to 3 minutes. Your answers to these questions will help us understand how you’re feeling and what you need. Based on your answers, we may reach out to you for more information or ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions. For more information, read About Your Recovery Tracker. Managing your painPeople have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medication. Some people have soreness, tightness, or muscle aches around their incision for 6 months or longer. This doesn’t mean something is wrong. Follow these guidelines to help manage your pain at home.
Preventing and Managing ConstipationTalk with your healthcare provider about how to prevent and manage constipation. You can also follow the guidelines below.
Caring for your incisionIt’s normal for the skin below your incision to feel numb. This happens because some of your nerves were cut during your surgery. The numbness will go away over time. Call your healthcare provider’s office if:
If you go home with staples or stutures in your incision, your healthcare provider will take them out during your first appointment after surgery. Cleaning your incisionIt’s very important that you keep your incision clean and remove any crust that develops on it. Crust can collect bacteria and lead to infection. Your healthcare provider will teach you how to care for your incision before you’re discharged. You do not have to clean your incision if you go home with Steri-Strips. Your healthcare provider may recommend you clean your incision with an antibacterial ointment such as Bacitracin®. To clean your incision with an antibacterial ointment, follow these steps.
Showering
Don’t take a bath for the first 4 weeks after your surgery. Eating and drinkingYou can eat all the foods you did before your surgery, unless your healthcare provider gives you other instructions. Eating a balanced diet with lots of calories and protein will help you heal after surgery. Try to eat a good protein source (such as meat, fish, or eggs) at each meal. You should also try to eat fruits, vegetables, and whole grains. It’s also important to drink plenty of liquids. Choose liquids without alcohol or caffeine. Try to drink 8 to 10 (8-ounce) glasses of liquids every day. If you have questions about your diet, ask to see a clinical dietitian nutritionist. Physical activity and exerciseAfter your sutures or staples are removed, your healthcare provider may instruct you to do certain exercises every day. This will depend on how well you can turn your neck and move your arm(s) after surgery. The exercises will help you regain full range of motion and strength to the affected area(s). It’s important that you do them every day. Your healthcare provider will show you how to do the exercises and will give you written instructions at first appointment after surgery. For more information, read Exercises After Your Neck Surgery. It’s normal to have less energy than usual after your surgery. Recovery time is different for each person. Increase your activities each day as much as you can. Always balance activity periods with rest periods. Rest is an important part of your recovery. Your healthcare provider will tell you when you can resume your normal activities during your post-operative visit. Until then, avoid all activity that could put strain on your incision, including:
Going back to workTalk with your healthcare provider about your job and when it may be safe for you to start working again. If your job involves lots of movement or heavy lifting, you may need to stay out a little longer than if you sit at a desk. Follow-up careYour first appointment after your surgery will be about 1 week after you’re discharged from the hospital. Until then, be sure to follow all instructions given to you when you were discharged. The lymph nodes that were removed during your surgery will be checked by a pathologist after your surgery. The test results are usually ready in 1 week. Based on the results, you may need further treatment. Your healthcare provider will discuss the results with you during your first follow-up appointment after your surgery. Managing your feelingsAfter surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support. Your healthcare provider can refer you to MSK’s Counseling Center. You can also reach them by calling 646-888-0200. The first step in coping is to talk about how you feel. Family and friends can help. Your healthcare providers can reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to you and your family. Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness. When to call your healthcare providerCall your healthcare provider if you have:
Monday through Friday from 9:00 a.m. to 5:00 p.m., contact your healthcare provider’s office. After 5:00 p.m., during the weekend, and on holidays, call 212-639-2000 and ask to speak to the person on call for your healthcare provider. Back to topSupport ServicesThis section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery. As you read through this section, write down questions to ask your healthcare provider. MSK Support ServicesVisit the Cancer Types section of MSK’s website at www.mskcc.org/types for more information. Admitting Office Anesthesia Blood Donor Room Bobst International
Center Caregivers
Clinic Counseling
Center Female
Sexual Medicine & Women’s Health Program Food Pantry Program Integrative Medicine
Service You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. To make an appointment, call 646-608-8550. Male Sexual and Reproductive Medicine Program MSK
Library Nutrition Services Patient and Caregiver Education Patient and Caregiver Peer Support
Program Patient
Billing Patient Representative Office Perioperative Nurse
Liaison Private Duty Nurses and Companions Resources for Life After Cancer (RLAC) Program This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues. Social
Work Our social workers can also help refer you to community agencies and programs. They also have information about as financial resources, if you’re having trouble paying your bills. Spiritual Care MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call. Tobacco Treatment
Program Virtual Programs Sessions are private, free, and led by experts. Visit our website for more information about Virtual Programs or to register. External support servicesAccess-A-Ride Air Charity
Network American Cancer Society (ACS) Cancer and Careers CancerCare Cancer Support Community Caregiver Action
Network Corporate Angel Network Gilda’s Club Good
Days Healthwell
Foundation Joe’s House LGBT Cancer Project LIVESTRONG Fertility
Look Good Feel Better
Program National Cancer
Institute National Cancer Legal Services Network National LGBT Cancer Network Needy Meds NYRx Partnership
for Prescription Assistance Patient Access Network Foundation Patient Advocate Foundation RxHope Head and neck cancer support servicesSupport for People with Oral and Head and Neck Cancer
(SPOHNC) Educational ResourcesThis section has the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery. As you read through these resources, write down questions to ask your healthcare provider.
Which complication would the nurse assess for in a client who is postoperative for radical neck surgery?Postoperatively, complications are uncommon. They include wound dehiscence, percutaneous or pharyngocutaneous fistula, infection, hematoma, sialocele, and chyle fistula.
What is radical neck surgery?Radical Neck Dissection
This operation has been used for almost 100 years and describes the removal of lateral neck nodes and tissues to surgically remove cancer in the neck. Included in this tissue, which extends from the collarbone (clavicle) inferiorly to the jawbone (mandible) superiorly are dozens of lymph nodes.
What are resected in radical neck dissection?There are several kinds of neck dissections, depending on the extent of resection involved. A radical neck dissection removes all the lymph nodes in the neck on one side, as well as the sternocleidomastoid muscle (SCM), the internal jugular vein (IJV), and cranial nerve XI or the spinal accessory nerve.
Which of the following medications used in the treatment of GERD accelerate gastric emptying?Prokinetic agents, such as metoclopramide (Reglan), improve the motility of the esophagus and stomach and increase the lower esophageal sphincter (LES) pressure to help reduce reflux of gastric contents. They also accelerate gastric emptying.
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Postoperatively, a client with a radical neck dissection should be placed in which position?
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