Lateral Neck Dissection

Because of extensive dissection along the large muscle on the side of the neck (sternocleidomastoid muscle), your neck will be very stiff immediately following surgery.

Your activity in life will be limited (namely driving and lifting things) until this stiffness resolves.

Therefore, it is very important to immediately work on range of motion exercises with your neck following your surgery.

• Up and down, sided to side, soft circles in both directions.
• Working through tightness is ok. If the movement causes pain, then stop.

Because of the need to cut through the sensation nerve fibers in the skin, you can expect to experience numbness from the jaw and ear lobe, down to your collar bone (sometimes even to your chest).

This numbness can last up to 9 months.

As the sensation nerve fibers start to heal and regain function, it is not uncommon to experience sensations of tingling, burning, itching, or pinching / shooting pains.

• These sensations are completely normal and indicate appropriate healing of the sensation nerve fibers in your neck.
• These sensations will resolve over the course of several weeks to months.

For 24 hours: Limit your activity for the first 24 hours following surgery and get plenty of rest as you recover from general anesthesia.

For 1 week: No heavy lifting or pushing (> 10lbs), active sports (e.g., running or jumping), strenuous exercise, heavy household work, or any activities that elevate your heart rate or blood pressure in order to reduce the risk of bleeding in your neck. Objects that cannot be lifted with one hand are considered too heavy.

• You may walk at a normal pace and do light household activities during the first week.

There are no activity restrictions after 1 week.

In general, you may plan to return to work in 10 days, 2 weeks if your job requires manual labor, or as otherwise instructed.

Due to the sore throat caused by the breathing tube and surgical dissection, we recommend starting with liquids and soft foods.

You may progress to solid foods (your normal diet) as tolerated; this may take 1 – 3 days.

There are no restrictions in the positioning of your head and neck following surgery. You may relax and sleep in whatever position that is comfortable for you.

• No need to sleep with your head elevated.

It is not uncommon for your sleep cycle to be affected by general anesthesia. Do your best to resume normal sleep patterns and avoid excessive daytime napping following the initial 24-hour rest period.

You can drive once you are off the strong (prescription) pain medication and when you can turn your head / neck to check your blind spots without hesitating. This may take 3 – 14 days depending on the stiffness in your neck.

Your incision was closed in two layers:

• Deep stitches which will dissolve on their own over the course of 8 – 10 weeks.
• A superficial layer of blue skin glue and strips of white bandages (steri-strips) embedded in the glue.

You may bathe or shower as soon as you like after surgery.

• It is ok to allow soap and water to run over the bandage.
• Do not submerge under water for extended periods of time (> 1 min).
• Do not scrub the incision; pat it gently dry with a towel afterwards.

If the glue and bandage is still present 2 weeks after surgery, you may peel off the bandage (Steri-Strip) and the rest of the glue.

• It is ok if the bandage comes off before two weeks. No need to cover the incision.
• If the white bandages start to curl off the skin before two weeks, you may carefully use scissors to trim the curled edges.

After the bandage comes off, you may notice several small bumps under the skin along your incision line and the incision line may appear raised.

• The bumps are the deep stitches that have yet to dissolve (this can take up to 8 – 10 weeks). They will dissolve with time and massages (see below) and the incision will eventually heal flat.
• If there are any concerns with the appearance of your incision once the bandage comes off, please take a picture and send it to Dr. Kay via MyChart messaging.

As your incision heals, it is not uncommon to experience sensations of tingling, burning, itching, or pinching / shooting pains.

• These sensations are completely normal and indicate appropriate healing of the sensation nerve fibers in your neck.
• These sensations will resolve over the course of several weeks to several months.

Once the bandage is off, please purchase over the counter Vitamin E oil from a pharmacy or supermarket (Vitamin E oil capsule which can be broken open are an acceptable alternative).

• Use the oil to massage your wound with the pads of your fingers, using a slow circular motion, as deep as you can tolerate.
• Perform this twice per day for 5 minutes at a time, for 1 month. You may massage more frequently or for longer periods.
• You may also use different kinds of scar ointments / creams such as Mederma, Biocorneum, etc. or silicone strips.
  • The important thing is that you do the massages as instructed above.

Once the bandage is off, please keep your incision out of direct sunshine for the first 3 months after surgery (using shade, a scarf, and/or sunscreen with SUV 30 or higher with both UVA and UVB protection) in order to prevent discoloration of the scar.

Pain control:

Ice compresses can help to treat swelling and pain around the incision. Apply for 10 min at a time. You can repeat every 30 minutes as needed.

Sore throat lozenges (particularly those with the active ingredient ‘Benzocaine’ such as found in Cepacol lozenges) will help to treat the discomfort deep in your throat.

Drinking fluids frequently will help the small scratches inside the throat caused by the breathing tube to heal more quickly and also relieve your pain faster.

Over the counter Tylenol (acetaminophen) can be taken every 6 hours as needed for pain relief, up to 1,000 mg each dose, do not exceed 4,000 mg total in 24 hours. Do not take 3,000 mg total per day for > 3 consecutive days.

Over the counter NSAID’s (Non-Steroidal Anti-Inflammatory Drugs)

• Ibuprofen, Motrin, or Advil can be taken every 6 hours as needed for pain relief, up to 400 mg each dose, do not exceed 1,600 mg total in 24 hours. Do not take more than 1,200 mg total per day for > 3 consecutive days.

OR

• Aleve (naproxen) can be taken every 12 hours as needed for pain relief, up to 550 mg each dose, do not exceed 1,100 mg total in 24 hours. Do not take 1,100 mg total per day for > 3 consecutive days.
• These NSAID’s can be alternated with Tylenol as in the below examples:
  • 500 – 1,000 mg of Tylenol every 6 hours, alternating and staggering with Ibuprofen 200 – 400 mg every 6 hours (essentially taking pain medication every 3 hours as needed).
  • 500 – 1,000 mg of Tylenol every 6 hours, alternating and staggering with Aleve 225 – 550 mg every 12 hours.

In situations when the above pain control regimen does not control your pain symptoms adequately, you were prescribed 5 tablets of a low dose narcotic medication (either Tramadol or Hydrocodone / Acetaminophen).

• You can take 1-2 tablets of this every 6 hours as needed for pain control.
• If required, these prescription pain medications are not usually needed for more than 24 hours after surgery.
• If you were prescribed Hydrocodone / Acetaminophen, please do not take any additional Tylenol or Acetaminophen at the same time.
• These medications may cause you to be drowsy. Do not drive / operate heavy machinery, drink alcohol, or take any other sedating medications while using the prescription narcotic pain medication.

Anti-Nausea Medication

If you are discharged home on the same day of surgery, you will be given an antinausea prescription called Zofran (ondansetron). This comes in a tablet form that dissolves underneath your tongue.

You can use this as needed if you are experiencing nausea. Please have a low threshold to use this in order to prevent vomiting (which can increase the risk of bleeding in your neck).

Stool Softener

You will receive narcotics as part of your general anesthesia on the day of surgery and you may also take a prescription narcotic pain medication following surgery. These narcotic medications can cause constipation.

In order to prevent this, you may consider purchasing an over-the-counter stool softener (such as docusate or senna) and take for 24-48 hours following surgery as directed on the package (especially if you are prone to constipation).

• If you remain constipated for > 48 hours after surgery despite the use of a stool softener, you may purchase a bottle of over-the-counter magnesium citrate and take as directed. If your constipation persists despite this, please contact the office for further instructions.

Prior Medications

• You should resume taking all other medications the day after surgery, unless instructed otherwise by your primary care provider.

Blood Thinning Medications

If you were on any blood thinners (Plavix, Coumadin, Eliquis, Xarelto, Aspirin, etc.) prior to surgery, please do no restart the medication until 5 days after your surgery to limit the risk of bleeding, unless instructed otherwise.

Due to the effects of the breathing tube being placed during surgery, you may experience thick mucus in your throat for 24-48 hours. It is ok to gently clear your throat and cough to clear this mucous.

If the sensation of mucous in your throat persists for > 48 hours, it is usually not because there is still mucous there. At this point, persistent inflammation and sensitivity of the vocal cords caused by the breathing tube can mimic the sensation of mucous and is best treated by drinking plenty of liquids, using over the counter throat lozenges with the active ingredient ‘Benzocaine’ such as found in Cepacol lozenges, and avoiding further throat clearing / coughing.

• Clearing your throat / coughing may cause your throat symptoms to worsen or persist, similar to scratching a mosquito bite.

Swelling beneath or near your incision site, particularly if it is visibly noticeable and/or causing pressure in the neck.

• Please call the office at 630.938.6161 and if possible, send a picture of your incision (one from directly in front of you and one from the side) via MyChart messaging.

If you notice rapid and progressive swelling in your neck, or bleeding from your incision, please call 911 as this could represent a hematoma, or active bleeding in the neck, and this is a medical emergency.

If you notice redness and itching around the bandage, especially if starting 24-48 hours after surgery, you may be experiencing an allergic reaction to the skin glue or the white steri-strip bandages.

• For this you can try taking over the counter Benadryl as directed on the package. If the symptoms do not resolve, please call the office at 630.938.6161 for further instructions as the bandage and glue may need to be removed.

Please record your drain output twice daily.

OK to get the drain wet in the shower.

Dr. Kay’s office will call to arrange drain removal 2 days following your surgery.

• If the drain output is > 50 cc or ml in a 24-hour period, please call the office at 630.938.6161 before coming to your appointment. In this scenario, the drain may need to stay in place longer.

When surgery is scheduled, an appointment should have been made for you to follow-up ~ 6 weeks after surgery.