Can Neck Lymph Nodes Be Removed?
Yes, lymph nodes in the neck can be surgically removed through various types of neck dissection procedures, which are standard, well-established operations in head and neck surgery. 1
Types of Neck Dissection
Neck lymph node removal is classified into two main categories 1:
Comprehensive neck dissection: Removes all lymph node groups from levels I-V (the classic radical neck dissection distribution), regardless of whether the sternocleidomastoid muscle, jugular vein, or spinal accessory nerve is preserved 1
Selective neck dissection: Removes specific lymph node levels based on the primary tumor location and expected drainage patterns 1, 2
When Neck Dissection Is Performed
The decision to remove neck lymph nodes depends on clinical staging 1, 2:
N0 disease (no clinically evident nodes): Selective neck dissection targeting levels I-III for oral cavity tumors or levels II-IV for oropharynx tumors 2
N1-N2 disease: Either selective or comprehensive neck dissection may be performed 2
N3 disease: Comprehensive neck dissection is recommended 1, 2
Clinically positive nodes: Any suspicious lymph nodes observed during surgery must be excised, even without radiotracer uptake, since gross lymphatic involvement may block tracer flow 1
Surgical Technique Considerations
The procedure involves making incisions along relaxed skin tension lines positioned to facilitate excision of the scar should subsequent neck dissection be required. 1 Key technical points include:
Lymph nodes are accessed through one or more small incisions and removed from levels I-V according to standardized anatomical classification 1
Subplatysma skin flaps are not routinely raised for biopsy-only procedures 1
Following excision, the surgical bed is rechecked to ensure no adjacent nodes requiring removal remain 1
Histologic examination typically yields 6 or more lymph nodes from selective dissection and 10 or more from comprehensive dissection 2
Risks and Complications
Neck dissection carries specific risks that must be considered 1:
Injury to facial and spinal accessory nerves is possible, with complication rates reported at less than 1% 1
The risk of nerve injury is theoretically higher during minimal-access procedures like sentinel node biopsy compared to formal neck dissection 1
Re-exploration of a recently operated field for completion dissection carries higher risks of nerve or vessel damage 1
Post-Treatment Management
After definitive treatment with radiation or chemoradiation, any patient with residual disease or suspected progression in the neck should undergo neck dissection. 1 For patients achieving complete clinical response (no visible/palpable disease and no radiographic abnormalities with nodes <1.5 cm), observation is recommended 1