Postoperative follow up of Neck Dissection

Dr. Erami M.D.ENT Resident

Department Of ENTShahid Sadoghi Hospital

Yazd Iran

•Discharge:• The patient is typically discharged once they have demonstrated the ability to• eat/drink normally• ambulate well• their pain is under control

• All of this typically occurs over the first 2-5 days.

•Follow-up appointment: • A routine follow-up visit is usually made for about one week (or within 10-14

days) after surgery.• Biopsy results will be discussed at first post-op appointment.

• suitable recovery period:• In general, four to six weeks

•Avoid during this time:•Driving• strenuous activity• lifting heavy objects or operating machinery

•Diet: • The patient is typically given clear liquids

• either in recovery, or upon transfer to the floor• softer foods are easier to manage, as chewing can be uncomfortable and difficult

• Depending on• the level of Grogginess• throat discomfort• whether they have nausea

• advanced to a regular diet rapidly over the first and second day. • Upon return home, there are no dietary restrictions. • Eat a healthy diet to maximize your recovery.

•Smoking :• Smoking affects the body’s ability to heal:• so stop or cut down.

•Activity:• We typically have the patient maintain head elevation while in bed during

the first week. • This reduces swelling and discomfort.

• during the first week:• We suggest no heavy lifting or vigorous activity.• We would request that the patient not travel during the first week.

• Patient can plan on being off from work for about 4 weeks if radiation or chemotherapy is needed it will be longer.

•pain:• The pain following a neck dissection is typically mild to moderate.• Most patients have good pain control with Tylenol, or a mild oral narcotic

pain medication for the first few days after surgery.• We do ask the patient to avoid NSAID’s• like Motrin, ibuprofen, Advil, Aspirin, or Aleve.

• It is common to have some mild throat pain for a day or two after this surgery • due to the proximity of the surgical site to the throat, and the breathing

tube which is in place during the surgery.

•nausea:• Nausea is occasionally present after a general anesthesia.• If present in the hospital:• can administer anti-nausea medications.

• If present after discharge:• anti-nausea medications can be called in by your surgeon or their office

staff.

•fever: • Fever is not expected after a neck dissection.• If a fever over 100 F (37.7 C) is present:• please call the physician.

•swelling:• Typically, the lower neck does mildly swell during the first 24-48 hours• then the swelling slowly subsides over a period of 1-2 weeks• If there is progressive swelling of the surgical site:

• please contact your surgeon

• Some firmness of the region around the incision :• is common for several months after surgery

•numbness: • as a result of bruising to the nerves• Most patients have numbness of the region around the incision for a period of weeks – to-

months• The ear is often numb for a longer period of time• This will improve to some extent, but should not expect it to return to normal.• most people do not have much pain afterwards.

•shoulder weakness:• Commonly the patient experiences temporary weakness of one of the

muscles in the shoulder region • This resolves slowly over several months after the procedure

•drains: • Occasionally the patient is sent home from the hospital with a surgical drain

in place. • This is easy to take care of, and the patient is informed about drain care by

the nursing staff prior to discharge.

•incision care: • The patient will have sutures in the neck and will be removed in 10-14 days.• Bacitracin should be placed on sutures for the 1st week after surgery. • After removal, a moisturizer may be used.• A patient can take a bath or shower 48 hours after surgery, but are not

allowed to submerge the wound under water.• Pat the area dry rather than rub it• avoid applying any perfumes, colognes or scented creams to the area until it

is fully healed.• Rarely, the wound can become infected. To reduce this risk:• be hygienic and regularly wash your hands with soap and water.• keep the area clean by using clean clothes, towels and bed linen.

•Exercises following head and neck surgery :•Which exercises and how often?

• You may start the exercises when all the drains have been removed from your neck. • The exercises are most effective when completed little and

often. •Repeat each exercise 5 times.•Aim to exercise 5 times a day.

•Repeat 5 times and exercise 5 times a day. •Hold each position, gradually increasing the time to 30

seconds as you become more comfortable.

• Following surgery you should continue these exercises for3 months.

• If you are having radiotherapy it is important to continue to exercise throughout the treatment.

1. Posture correction Sit down.

• Look straight ahead with your head upright.• Keep your shoulders level and held back. • Use a mirror to check your position.• This is your starting position for all the exercises.

2. Flexion

• Bend your head down• tucking your chin into your chest.• Hold in this position and then return to starting position.

3. Extension

• Tilt your head back• pointing your chin towards the ceiling.• KEEP YOUR LIPS CLOSED. • Hold this position then return to starting position.

4. Side flexion

• Bend your head to the side• trying to get your ear as close toyour shoulders you can.Hold position and return to starting position.Repeat on both sides.

5. Rotation

• Turn your head to the side.• You are trying to look over your shoulder.• Hold this position and then return to starting position.Repeat on both sides.

6. Neck retraction

• Keep your head level and pull your chin in.• Do not tip your head forwards.• Hold this position then return tostarting position.

7. Lateral flexion and extension

• Tilt your head back pointingyour chin towards the ceiling. KEEP YOUR LIPS CLOSED.Turn your head to the side.Hold this position and thenreturn to starting position.Repeat on both sides.

8. Elevation

• Lift your shoulders up towards your earsas far as you can.Try to keep your shoulders levelwith each other.Hold this position and thenreturn to starting position.

9. Depression

• Lower your shoulders away from your ears as far as you can.Hold this position then returnto starting position.

10. Retraction

• Pull both of your shoulder blades backwards.• You will feel a stretch across your chest.• Hold this position and then return• to starting position.

11. Shoulder flexion

• Bend your arm.• Lift your elbow forwards and upwardsas high as you can.Hold this position then returnto starting position.Repeat on both sides.

12. Abduction

• Bend your arm.• Lift your elbow out towards the sideuntil it is level with your shoulder.Hold position and return to starting position.Repeat on both sides.

•Call Doctor?

• If increased swelling or bruising. • If severe or increased pain not relieved by medication • If any side effects to medications• such as, rash, nausea, headache, vomiting, increased irritability, or

constipation• If an oral temperature over 100.5 F (38 C) degrees

Thanks for your

attention