Neck dissection

Radical neck dissection

Unilateral en bloc removal of the neck lymph nodes levels I to V (see level system of lymph node classification), including the sternocleidomastoid muscle, internal jugular vein, submandibular gland and spinal accessory nerve. Loss of this nerve causes much discomfort (shoulder drop and pain). If the spinal accessory nerve is preserved, the procedure is called a modified radical neck dissection (see pedicled flap (VI:2), Fig. 1).

Modified neck dissection

If the spinal accessory nerve and one more of the above mentioned structures removed in a radical neck dissection is preserved, the procedure is called a functional or conservative neck dissection. This type of dissection is performed when there are no or only small positive lymph nodes present in the neck.

In a selective neck dissection, a more limited number of lymph nodes levels are removed. A commonly performed selective neck dissection is a supraomohyoid neck dissection: this includes removal of levels I, II and III and is performed when a small cancer of the oral cavity is removed and no positive lymph nodes are present.

RH