The role of a modified neck dissection
Since the 1960s, head and neck surgeons have gradually developed an understanding of how and when the lymph nodes in the cervical drainage areas for cancers of the oral cavity, oropharynx, larynx and hypopharynx, as well as for cancers of the skin can be removed while preserving functionally and cosmetically vital anatomic structures . In addition, knowledge has been gained as to which regional nodal groups are at highest risk for containing metastatic cancer, depending upon the location of the primary cancer. Consequently, many regional lymphadenectomies have been suggested to fit the potential extent of the cervical metastasis. Although this approach has been applicable for squamous carcinoma, recently, modifications of the radical neck dissection have been reported for the treatment of melanoma and thyroid carcinomas [2, 3]. The use of immediate postoperative irradiation with the modified neck dissection is advised when certain adverse criteria have been identified which carry a high risk for local-regional recurrence if surgery is used as the only modality of treatment . From a conceptual standpoint, the value of the various selective neck dissections is still evolving and hopefully will soon become standardized.
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