7. Radial Neck Dissection and Selective Radial Neck Dissection

Radial Neck Dissection

• involves removal of all cervical lymph nodes from the mandible to the clavicle

• removal of the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve on one side of the neck.

• shoulder drop/dysfunction and poor cosmesis (visible neck depression).

associated complications Radial Neck Dissection

Modified Radical Neck dissection

preserves one or more of the nonlymphatic structures

• in comparison to a radical neck dissection

• preserves one or more of the lymph nodes groups,

  • the internal jugular vein, the sternocleidomastoid muscle,

  • the spinal accessory nerve

• Assess knowledge

• Assess for risks for potential complications

• Postoperatively, the patient will need careful monitoring and assessment:

  • Airway and breathing

  • Pain

  • Potential bleeding and wound drainage system

  • Other

Assessment

Major goals include:

• Patient participation in the treatment plan

• Maintenance of respiratory status

• Attainment of comfort

• Absence of infection

• Viability of graft

• Maintenance of adequate nutrition fluid and intake

• Effective coping strategies

• Effective communication

• Maintenance of neck and shoulder notion

• Absence of complications

planning

• Knowledge deficiency

• Ineffective airway

• Acute pain

• Impaired tissue integrity

• Imbalanced nutrition

• Impaired physical mobility secondary to nerve injury

diagnosis

• Hemorrhage

• Chyle fistula

• Nerve injury

collaborative problems/potential complications

• Frequent assessment

• Place in Fowler’s position

• Encourage coughing and deep breathing

• If the patient has a tracheostomy, provide tracheostomy care as required.

Maintaining the airway

• Patient should be aware of the extent and nature of the surgery and what to expect in the postoperative period.

• Patient and family will require postoperative teaching related to self-care and home management:

  • Signs and symptoms to report

  • Wound care, dressings, and drains if present

  • Diet and medications

  • Exercises and activity

• Speech therapy, support resources, and follow-up care

patient education

• Suctioning should be done with great care to protect suture lines.

• Support the head and neck when moving the patient

• Assess wound drainage system and empty as require

• Assess dressings, wound, and graft condition.

Impaired Tissue Integrity

• Assess nutritional state preoperatively and intervene early to prevent nutritional problems.

• Encourage high-density, high-quality intake.

• Diet may need to be modified to liquid diet, or to soft, pureed, and liquid foods.

• Consider patient preferences and cultural considerations in food selection.

• Provide oral care before and after eating.

• Nasogastric or gastrostomy feedings may be required.

Imbalanced Nutrition