Radical Neck Dissection — Procedure Guide, Recovery & Risks | MyMedicPlus

Radical neck dissection (RND) removes cervical lymph node levels I-V with their fascial envelopes along with the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve (CN XI) to eradicate cancer in the neck.

Indicated for head and neck squamous cell carcinoma with multiple or bulky cervical lymph node metastases, thyroid and parotid malignancies with nodal disease, and cases where modified radical neck dissection cannot achieve clear margins.

Under general anaesthesia, a transverse neck incision exposes the neck. Lymph node levels I-V are dissected with fascial envelopes. The SCM, IJV, and CN XI are divided and removed. Haemostasis is achieved and a closed drain placed.

Hospital stay is 5-7 days; drains are removed when output is below 30 mL per day. Shoulder physiotherapy begins immediately to compensate for CN XI sacrifice. Sutures are removed at 10-14 days; full recovery takes 6-8 weeks.

CN XI sacrifice causes shoulder drop and chronic pain. IJV ligation causes transient facial edema. Chyle leak occurs in 1-2% of cases. Additional risks include wound infection, hematoma, marginal mandibular nerve injury, and carotid exposure.

5-year regional control rates are 70-80% for N1-N2 disease. Modified radical neck dissection with CN XI preservation provides equivalent oncologic control in most cases with significantly better functional outcomes and quality of life.