Evolution of neck dissection for improved functional outcome.

Neck dissection plays a crucial role in the management of metastatic neck disease. Until recently, radical neck dissection has been the standard treatment for malignant cervical adenopathy irrespective of the nodal staging. However, in recent years, there has been a trend toward the development of more conservative operations, wherein certain nonlymphatic structures and lymph node groups can be selectively preserved. Radical neck dissection still remains the surgical standard against which various modifications must be compared. The need to perform more conservative surgery comes from the realization that the radical operation is attended by significant postoperative morbidity, and that some of the structures removed in the course of this operation can actually be preserved without any compromise in oncologic safety. The purpose of this article is to discuss the evolution of conservation surgery in the management of metastatic neck disease, define the clinical applications of various types of neck dissection, and evaluate the implications of these conservation approaches on preservation of function.