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Neck dissection is a surgical procedure that is designed to remove metastatic cancer involving the cervical lymph nodes.

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The gold standard procedure is the radical neck dissection.

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Modifications of the radical neck dissection procedure include the modified radical neck dissection, which has been designed to reduce morbidity by sparing nonlymphatic structures, and selective neck dissection, which is used for treating early nodal disease by removing only the lymph node groups at greatest risk for harboring metastases.

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The lymph nodes in the neck are grouped into six major levels (I to VI) with additional division into two sublevels (A and B) of levels I, II, and V.

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Clear anatomic, radiologic, and surgical landmarks are used to define the borders between the different levels.

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The term therapeutic neck dissection is used when there is clinical evidence of metastatic cervical lymphadenopathy.

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The term elective neck dissection is used when the procedure is performed to remove lymph node groups that have an increased risk of harboring occult disease in the neck.

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A planned neck dissection, performed whenever there is a high risk of residual cancer, is typically done 6 to 8 weeks after other treatment to the neck has been completed, such as radiotherapy or chemoradiotherapy, regardless of the clinical response to the initial treatment.

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A “salvage” neck dissection is done when there is clinical evidence of metastatic disease in the neck after previous treatment. It can further be classified as early versus late depending on whether there is persistent versus recurrent neck metastases.

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Complications of a neck dissection include air leaks, bleeding, chylous fistula, facial or cerebral edema, blindness, carotid artery rupture, and damage to nerves such as the phrenic, vagus, brachial plexus and cutaneous nerves and the mandibular branch of the facial, hypoglossal, or lingual nerves.

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A neck dissection following chemoradiation therapy poses special challenges because the indications and the extent of the procedure remain controversial.