Article written by Dr Ameen, ENT Specialist Kuala Lumpur
A neck dissection involves the surgical removal of lymph nodes from the neck. I perform this procedure to treat cancers that have spread from the head and neck region to the cervical lymph nodes. The surgery requires careful dissection around vital structures like the spinal accessory nerve, internal jugular vein and carotid artery. Depending on the extent of the disease, I may perform a radical, modified radical or selective neck dissection. The operation typically takes three to five hours. Patients usually stay in a private hospital in Kuala Lumpur for two to four days for close monitoring and drain management.
Indications for Neck Dissection
- Metastatic squamous cell carcinoma: The most common reason for surgery, where cancer from the oral cavity, throat or larynx has spread to the neck lymph nodes.
- Metastatic thyroid cancer: Removal of affected lateral neck lymph nodes in patients with papillary or follicular thyroid carcinoma.
- Salivary gland malignancies: Cancers of the parotid or submandibular glands that have metastasized to the cervical lymph nodes.
- Unknown primary malignancy: When a patient presents with a neck mass that biopsy confirms as cancer, but the primary source is not immediately found.
- Prophylactic elective neck dissection: Removing lymph nodes at high risk of microscopic spread in patients with advanced primary head and neck tumours.
Complications of the Surgery
- Chyle leak: 2 to 5 percent. Injury to the thoracic duct on the left side of the neck causes milky lymphatic fluid to leak into the wound bed.
- Shoulder dysfunction: 10 to 20 percent. Stretching or sacrifice of the spinal accessory nerve leads to weakness in lifting the arm and shoulder droop.
- Marginal mandibular nerve weakness: 5 to 10 percent. Temporary or permanent weakness of the lower lip, causing an asymmetric smile.
- Haematoma formation: 2 to 4 percent. Bleeding in the neck wound that may require a return to the operating theatre to secure the airway.
- Salivary fistula: 3 to 6 percent. Leakage of saliva from the parotid gland tail into the neck wound.
- Horner syndrome: 1 to 2 percent. Damage to the sympathetic chain causes a drooping eyelid, constricted pupil and lack of sweating on one side of the face.
- Carotid artery blowout: Less than 0.5 percent. A rare but life-threatening complication where the carotid artery ruptures, usually in the setting of wound infection or prior radiation.
Estimated Procedure Cost (Professional Fees)
Medical fees in Malaysia are guided by the Private Healthcare Facilities and Services Act. Based on the PHFSA 2013 regulations for a block dissection of cervical lymph nodes (Code T8510), the maximum allowable professional fees are:
- Surgeon Professional Fee (CMO 1): RM2,895 (per side)
- Anaesthetist Professional Fee (MAJOR+ 3): RM1,125
- Total Maximum Professional Fees: RM4,020
Total Estimated Cost
- Total Estimated Cost (including hospital facility fees, operating theatre charges, specialised equipment rental, medications and consumables): RM16,000 to RM19,000 (not including primary tumour resection)
- Disclaimer: This is an estimated total cost only. Actual bills vary significantly depending on the specific hospital, room type and individual patient needs across Malaysia. Patients should always request a detailed itemised cost estimate from their chosen hospital or medical centre before proceeding.
Frequently Asked Questions
Will I have a visible scar after the surgery? Yes, the incision is typically placed in a natural skin crease across the lower neck. The scar fades significantly over six to twelve months and can often be concealed by a shirt collar.
How long do the surgical drains stay in place? You will usually have one or two drain tubes in your neck to prevent fluid accumulation. These are typically removed after three to seven days once the daily fluid output drops to a safe level.
Will my shoulder function return to normal? If the spinal accessory nerve is preserved, shoulder function usually improves significantly with targeted physiotherapy over a few months. Permanent weakness is more common if the nerve had to be sacrificed due to direct tumour involvement.
Do I need radiation therapy after a neck dissection? Postoperative radiation therapy depends on the final pathology report. If the pathology shows multiple involved lymph nodes or extracapsular spread, adjuvant radiation is highly recommended to reduce the risk of recurrence.
Can this surgery be combined with tumour removal? Yes, I frequently perform a neck dissection at the same time as the removal of the primary tumour in the mouth, throat or larynx. Combining the procedures requires only one anaesthetic and a single recovery period.
When to Seek Consultation
Facing a head and neck cancer diagnosis is overwhelming, but modern surgical techniques allow us to remove the disease while preserving vital neck structures and maintaining your quality of life.
If you have noticed a persistent lump in your neck or have been diagnosed with a head and neck malignancy, do not delay your care. Book a consultation at my Kuala Lumpur clinic for a thorough examination and imaging review. We will map out a clear and personalized treatment plan to address your condition.
About the Author
Dr Ameen is a practicing ENT Specialist based in Kuala Lumpur, Malaysia. He focuses on evidence based surgical and medical management of ear, nose and throat conditions. With extensive experience in head and neck oncology and complex reconstructive surgeries, Dr Ameen prioritizes clear communication and precise surgical techniques to ensure the best functional outcomes for his patients.
