Results of Selective Neck Dissection in Management of the Node-Positive Neck

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Abstract
THE PRIMARY goal in the treatment of patients with head and neck cancer is control of the disease. However, with increasing recognition of the substantial morbidity of radical surgical treatment, more emphasis is being placed on surgical conservatism if it does not negatively impact disease control and if it offers improved posttreatment function and cosmesis. The evolution of neck dissection is representative of this trend. Radical neck dissection, first described by Crile1 in 1906, has served as the standard method of managing cervical metastases in patients with head and neck cancer for most of the century. Radical neck dissection accomplishes en bloc removal of all cervical lymphatic contents believed to be involved with or at risk for metastatic disease from head and neck malignancy and includes removal of the sternocleidomastoid muscle, internal jugular vein, submandibular gland, and spinal accessory nerve. This operation produces substantial postoperative morbidity from cosmetic and functional standpoints, with typical shoulder dysfunction seen after this surgery.2 With time, surgeons have challenged the necessity of such radical neck surgery and have explored the feasibility of modifications to it.