Management of clinically negative neck for the patients with head and neck squamous cell carcinomas in the modern era.

Management of the cervical metastases is of paramount importance in the treatment of patients with head and neck squamous cell carcinoma (HNSCC). Head and neck oncologists continue to debate the appropriate approach of the clinically negative neck among patients with HNSCC. There are three management options: (A) Observation, reserving therapeutic neck dissection for only those patients who subsequently develop metastatic disease in the neck. (B) Staging with reserving definitive treatment for those who are found to have subclinical disease in the neck. Staging may require the use of imaging techniques or "staging" neck dissection. In the latter case a selective neck dissection (SND) is usually recommended, but it is still controversial if this surgical procedure for clinically negative neck is a staging or a therapeutic approach. (C) Elective treatment of the neck using neck dissection, radiation therapy or both. All these strategies may be appropriate, depending on the clinical circumstances and will be discussed in this review.