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#190882 10-07-2015 08:37 AM
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It's been awhile since I've posted, and I have questions about my latest development on this cancer journey After another surgery last January for a recurrence in the alveolar ridge and retromolar trigone, they just discovered a lump in my neck which does show up as cancerous on the recent PET scan. Next week I will undergo a neck dissection to remove the lymph nodes on the left side. No chemo or radiation is planned at this time. Any information/advice on this procedure would be greatly appreciated. I am in excellent health otherwise, and have always tolerated surgery well. Thank you all!


Teacher Karen
DX: SCC of right maxillary alveolar ridge, 9/2010.
Surgery 11/2010, removal of 4 teeth and gum.
Surgery 11/2012, removal of 3 teeth and gum.
IMRT 1/2013-2/2013
Surgery 1/2015 retromolar trigone resection; removal of 1 tooth and gum.
Surgery 10/2015 left modified radical neck dissection, inferior parotidectomy, external carotid artery resection.
Cetuximab based chemoradiation 64.8 Gy to resection bed.
Surgery 6/19/2018 Right inferior maxillectomy, bilateral low palate resection
Joined: Jun 2007
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Im so sorry you are going thru another surgery!

Ive had a neck dissection done too. One thing I can advise is to get PT started as soon as you can after surgery. This is very important for your range of motion. This type of surgery affects the ability to lift your arm and even something as simple as turning your head. By starting PT quickly hopefully you can avoid having problems later.

Best wishes with your upcoming surgery.


Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07
-65 lbs in 2 mo, no caregvr
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo xtended hospital stay, ICU & burn unit
PICC line IV antibx 8 mo
10/4/10, 2/14/11 reconst surg
OC 3x in 3 years
very happy to be alive smile
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Posts: 1,024
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Hi Karen, a neck dissection is no biggie in itself. Kris has undergone this twice.
Seeing as how nerves are usually severed it is a relatively painless procedure. You will usually have a small suction bottle hanging out of the neck which is usually removed the day after surgery, and then be discharged home. Many do complain of neck and facial numbness following this surgery. Some get some improvement, some don't. Kris has no concerns over this.
As Christine mentioned, get your physiotherapy started as soon as possible. Otherwise you will have many problems with lifting your arm on the affected side above shoulder height. Early physio will avoid any of these difficulties.
All will go well, take are,
Tammy


Caregiver/advocate to Husband Kris age 59@ diagnosis
DX Dec '10 SCC BOT T4aN2bM0 HPV+ve.Cisplatin x3 35 IMRT.
PET 6/11 clear.
R) level 2-4 neck dissection 8/1/11 to remove residual node - necrotic with NED
Feb '12 Ca back.. 3/8/12 total glossectomy/laryngectomy/bilat neck dissection/partial pharyngectomy etc. clear margins. All nodes negative for disease. PEG in.
March 2017 - 5 years disease free. Woohoo!
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Thank you Christine and Tammy. I appreciate you both taking the time to share your experiences. I would love to hear from others as I know a number of people here have had this surgery. Thanks!


Teacher Karen
DX: SCC of right maxillary alveolar ridge, 9/2010.
Surgery 11/2010, removal of 4 teeth and gum.
Surgery 11/2012, removal of 3 teeth and gum.
IMRT 1/2013-2/2013
Surgery 1/2015 retromolar trigone resection; removal of 1 tooth and gum.
Surgery 10/2015 left modified radical neck dissection, inferior parotidectomy, external carotid artery resection.
Cetuximab based chemoradiation 64.8 Gy to resection bed.
Surgery 6/19/2018 Right inferior maxillectomy, bilateral low palate resection
Joined: Jul 2009
Posts: 1,406
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Karen,I won't put my experience down as normal as there were complications. Rare as I've seen here on the board, guess I was just lucky.

The operation is an excellent one and should be if not a breeze than something far this side of a hurricane. Mainly I felt stiff and a little weird for awhile, but those feelings subsided.

Although there was some pain while I was in the hospital, they managed it very well and there was little residual pain. Now 6 years out I'm just left with some tongue numbness and a bit of stiffness on the left side that frankly I don't even notice any more.

You'll come through it with flying colors I'm sure!

We're here to help, so ask any and all questions.

(oh and I recommend that you NOT do what I did: watch the whole operation on YouTube the week before!)


David 2
SCC of occult origin 1/09 (age 55)| Stage III TXN1M0 | HPV 16+, non-smoker, moderate drinker | Modified radical neck dissection 3/09 | 31 days IMRT finished 6/09 | Hit 14 years all clear in 6/23 | Radiation Fibrosis Syndrome kicked in a few years after treatment and has been progressing since | Prostate cancer diagnosis 10/18
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Ha ha, David2! Of course I want to watch that video right now! smile Thanks for sharing your experience. I'm curious what your complications were? (If you don't mind sharing.) I always find going into these procedures with as much information as possible to be very helpful. Thanks!


Teacher Karen
DX: SCC of right maxillary alveolar ridge, 9/2010.
Surgery 11/2010, removal of 4 teeth and gum.
Surgery 11/2012, removal of 3 teeth and gum.
IMRT 1/2013-2/2013
Surgery 1/2015 retromolar trigone resection; removal of 1 tooth and gum.
Surgery 10/2015 left modified radical neck dissection, inferior parotidectomy, external carotid artery resection.
Cetuximab based chemoradiation 64.8 Gy to resection bed.
Surgery 6/19/2018 Right inferior maxillectomy, bilateral low palate resection
Joined: Jul 2012
Posts: 3,267
Likes: 1
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I had five neck dissections, three that were radical, on the same left cervical neck within 3 years, and can pretty much back what everyone else has said. The surgery can be somewhat an easy, easier than chemo, radiation for me, in the hands of an experienced ENT surgeon, hospital, who do these surgeries frequently, but as with any surgery, there are risks, especially with all the vital structures in that area.

Not sure of the type of neck dissection you're having, there are several types, but in my case, I was scheduled for a Modified Radical Neck Dissection, MRND, which is more popular these days over a Radical Neck Dissection, RND, but during surgery all the nerves, veins, and tumor were all were all twisted together from prior radiation that it necessitated having a radical neck dissection, removing not only the nodes in level ll-V, but also the vein, nerve, and muscle instead of preserving them as with a MRND. The tumor was also found to be on the carotid artery, so it had to be scraped off, and Alloderm placed on the carotid to protect it since a Pec-flap wasn't planned, which otherwise would have been done, but later on was in another surgery.

Even so, recovery was fairly easy, I was in the hospital overnight in what is called a "step down unit," similar to ICU, where your are monitored closely. I had a tube in the neck to drain the fluids into a drainage bulb, which is supposed to be left in until it only fills up 1/3, and is usually left in until discharge or later, otherwise lymph fluid, blood, can build up in the neck and need to be drained by needle if excess swelling occurs. My tube was taken out prior to discharge, in addition too, the Foley catheter, I didn't know they were putting in. On the way home I stopped at McDonald's to pick up a BigMac, fries and a coke, so swallowing wasn't that bad.

Healing may take longer with prior radiation, and mine did, so instead of having the stitches removed around 7 days, mine were in there for about 21 days, in the "T Cut" incision. Btw, there are several type of incisions, depending on surgery, surgeon, but most try to have it along the creases in the neck to be more aesthetic since it can go from ear to mid neck.

As far as surgery side effects, mine were minimal at first, but having had 5 extensive neck surgeries, and 5 radiation treatments, it's difficult to differentiate what is from which, but I do have neck lymphdemia, fibrosis (turkey neck & leather neck), limited range neck motion, arm paralysis from brachial plexopathy, muscle atrophy in trapezoid, delts, bicep and Triceps, neuropathy in arm, hands, Horner's syndrome, head drop, as some.

As recommended, physical therapy may help, and may be life long, as well as having lymphatic drainage massage by a licensed therapist, to help prevent fibrosis from set in from lymph accumulation, which then may be permanent, and very little that can be done after that.

Pain was minimized by oxycodone, and may have been given morphine injection in the recovery room, usualyl do, which I never turn down, as pain can interfere with the healing process, as I later learned, and I wasn't trying to tuff anything out for no reason.

Good luck, and I hope this helps.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






Joined: Apr 2015
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As you can see, I had a right modified neck dissection when they did my partial glossectomy and tumor removal. I went home the next day. I had the same JP drain in place that it sounds like everyone gets! It was sore and puffy for sure, but it wasn't really all that painful. It was stressed to me to massage and stretch the neck starting as soon as tolerable to break up scar tissue and increase flexibility. I could only do a bit at the beginning, but by adding a heating pad to the equation early on, I found that once heated, the area was able to move about more freely with less discomfort. The lower right side of my face and my right ear felt numb for probably 6-8 weeks but now it's pretty much back to regular. My right arm was weak and "floppy" for about a month then started improving. I pride myself on my ability to defend myself, so I found this issue quite distressing, and had me feeling somewhat vulnerable where I never really felt that way before. Now, it's all good. Full range of motion, and doing weights as always, no problem. So, that's my story. Good luck to you. Denise

Last edited by Neicy; 10-09-2015 04:48 PM.

Biopsy tongue 3/24/15
Diagnosis SCC tongue/floor of mouth
Partial glossectomy, resection and right neck dissection done
4/22/15
T2aN0M0
05/01/2015-no further treatment indicated at this time,
monthly check ups for two years
Joined: Feb 2013
Posts: 53
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Thank you Neicy and PaulB for sharing your stories. I'm so sorry for all you've been through.


Teacher Karen
DX: SCC of right maxillary alveolar ridge, 9/2010.
Surgery 11/2010, removal of 4 teeth and gum.
Surgery 11/2012, removal of 3 teeth and gum.
IMRT 1/2013-2/2013
Surgery 1/2015 retromolar trigone resection; removal of 1 tooth and gum.
Surgery 10/2015 left modified radical neck dissection, inferior parotidectomy, external carotid artery resection.
Cetuximab based chemoradiation 64.8 Gy to resection bed.
Surgery 6/19/2018 Right inferior maxillectomy, bilateral low palate resection
Joined: Feb 2012
Posts: 31
Likes: 4
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Hello. I underwent a radical neck dissection within the first week after completing my IMRT. It was the final step in my treatment process. I agree with everyone else who has suggested starting PT as soon as possible. I was not advised to do so, and ended up with complications which restrict the opening of my mouth. This in turn makes it almost impossible to get food into my mouth, especially when I'm wearing my dentures. Often I cannot even open wide enough to get the fork or spoon in. I also suffer from recurring muscle pain and spasms in my jaw.

I also agree the procedure was by far the easiest of all the treatments I received ( i.e. Chemo, IMRT, and even the hemiglossectomy itself). Mine was performed on the right side of my neck, and initially I had numbness which extended from my temple down to the incision site, including the whole right side of my face. Most feeling has returned and the numbness that still persists is so normal to me now I only notice it when I touch my lower right jaw, and really focus on it.

It is true that post op I had drainage devices (I believe they're called JPs) in my neck for a few days. I knew I looked bad simply by the looks on the faces of my visitors. Finally I got enough courage to look in the mirror; and it was a frightening sight. However it looked much worse than it felt, and as soon as the drainage tubes were removed I knew everything would be OK.

I wish you the best, and can reassure you, after 10 years people can barely tell I underwent this procedure. Fear of the surgery and vanity (not wanting folks to see the scar initially) were the worst part of it. Good luck to you.


Age 59
DX SCC T3N1M0 R BOT 10/04 135lbs
TX Hemi-Gloss 11/04
MET Neck 12/04
TX 01/05 G-Tube,PortCath,6wks chem+6wks chem& IMRT,Max dose
06/05 RND,42 nodes 1 bad,All clear 120lbs
DX femoral hernia 09/09,repair 10/09 94lbs
HBO 11-12/10
11/10 All teeth out,05/11 dentures
DX hypothyroid,04/13
DX inguinal hernia,repair,04/15 127lbs
DX cachexia (CACS),03/16 98lbs
DX EPI, TX PERT,10/18 115lbs
DX RFS,11/18
DX iron deficiency anemia,02/19 118lbs
TX infusions,04-06/19 115lbs
DX calcified atheroma carotid
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