Neck Dissection Details

Central Neck Dissection

The most common place for thyroid cancer to spread is to the lymph nodes right around the thyroid and along the windpipe just below the thyroid. This area is called the central neck. Removing lymph nodes in this area to eradicate cancer is known as a "central neck dissection."

In some patients undergoing a thyroidectomy for cancer, a central neck dissection might be performed at the same time as the thyroidectomy. We do this because the lymph nodes in the central neck are a common site of recurrence of thyroid cancer. Removing these lymph nodes at the time of your thyroidectomy may reduce your risk of requiring another operation in the future.

A central neck dissection removes all the lymph nodes from the area just below your voice box (larynx) to the top of your breast bone. Removal of these neck lymph nodes will not impair your immune system’s ability to fight infections.

If you are undergoing a thyroidectomy, the central neck dissection will be performed through the same incision (located in a curve in the skin of the lower neck). If you have already had a thyroidectomy, the previous incision will be used for the neck dissection, but the incision may need to be extended.

The operation usually takes 2 to 3 hours if you have previously had a thyroidectomy. If performed at the same time as a thyroidectomy, the central neck dissections adds about 30-60 minutes to the surgery time.

Care is taken to protect the nerves to the vocal cords as well as the parathyroid glands. Occasionally, this operation requires relocation of the two lower parathyroid glands. When this is necessary, the parathyroid glands are placed into a pocket in one of the muscles of the neck, where they begin to grow again and resume their function. This is known as a parathyroid autotransplant.

Occasionally, a thin plastic tube (drain) may be placed at the time of the surgery and will come out the skin below your collar bone. If placed, this drain will usually be removed prior to your discharge from the hospital.

The scar from the procedure should fade over time. It is often less noticeable than patients expect since the incision is made along a natural crease in the skin of the neck.

Risks of Central Neck Dissection

Two main complications of a central neck dissection are as follows:

1. Hoarseness

The lymph nodes in the central neck are very close to the nerves to the vocal cords (recurrent laryngeal nerves) which run under the thyroid gland on either side of the neck. Injury to one of these nerves can cause hoarseness due to a paralysis of the vocal cord. A permanent vocal cord paralysis occurs in about 1% of patients. Approximately 10-15% of patients will have mild hoarseness resulting from operating around the larynx, but this hoarseness is temporary, lasting days to months.

2. Low Blood Calcium (Hypoparathyroidism)

Approximately 15% of patients experience low calcium directly following a neck-dissection surgery. This can cause a feeling of numbness or “pins and needles” (similar to the sensation you experience when your hand “falls asleep” after you have slept in an awkward position). Low calcium can also lead to muscle spasms. However, only 2-5% of patients will need to take calcium supplements on a long-term basis.

Note: Multiple Operations

If you have had a previous thyroidectomy and are undergoing a central neck dissection for cancer recurrence, there may be scar tissue from the previous operation. This may slightly increase the risk of both nerve injury and parathyroid problems as compared to a central neck dissection performed at the same time as a thyroidectomy.

When a patient is diagnosed with thyroid cancer, it is important to consider the possibility that that the cancer may have spread to lymph nodes in the neck. However, physical symptoms experienced by the patient provide only limited guidance in determining whether this has occurred.

  • Enlarged lymph nodes can be a sign that cancer has spread to the lymphatic system, but they can also have other causes, such as inflammation and infection.
  • Lymph nodes containing cancer are often not palpable (i.e., cannot be felt by hand) and cause no symptoms.

When cancerous lymph nodes are palpable, they are usually felt as painless, firm lumps at the side of the neck. When symptoms do occur, it is usually due to the enlarged lymph node pressing on surrounding structures such as the esophagus (swallowing difficulty), the windpipe (trouble breathing), or nerves (pain or hoarseness).

Because of the difficulty in determining whether the cancer has spread from symptoms alone, diagnostic tests are usually performed.

This information is provided by the Department of Surgery at the University of Colorado School of Medicine. It is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.