Neck Dissections: History, Classification, and Indications

Surgical management of the cervical lymph nodes represents an essential element of comprehensive care for patients with oral/head and neck cancer. The histopathologic status of these lymph nodes remains the primary prognostic index for patients with squamous cell carcinoma of this anatomic region. It is therefore essential for ablative surgeons to establish and apply a scientific and sound philosophical approach to neck surgery to improve the potential for long-term survival, and possible cure of patients with oral/head and neck cancer. Such an approach is applicable to both the clinically positive neck (cN+) and the clinically negative neck (cN0). In fact, a distinct survival advantage exists when executing selective neck dissections for occult neck disease. This chapter reviews the history, classification, and indications for neck dissection in patients with oral/head and neck squamous cell carcinoma.