Elective Neck Dissection for Clinically N0 Neck in Squamous Cell carcinoma of the Head and Neck

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On the basis of our experience, we investigated the indication, the required extent and the suitable procedure for elective neck dissection (END) of clinically N0 neck (deep lateral cervical nodes) in squamous cell carcinoma of the larynx, hypopharynx, oropharynx and tongue & oral floor. A representative technique for END at our clinic, i. e. lateral neck dissection (LND) were described. We considered that if the probability of occult neck metastasis was greater than 20 %, END would be warranted. The indication was clarified by clinical T category and tumor site. Most of the occult neck metastses were found in level II, III, IV, and very few, i. e. 5 % (5/92) in level V. The rates of recurrence in the dissected neck were 4 % (5/120) for LND and 8 % (1/12) for RND in the patients with carcinoma of the larynx, hypopharynx or oropharynx, and were 12 % (3/26) for supraomohyoid neck dissection (SOND) and 14 % (1/7) for RND in those with carcinoma of the tongue & oral floor. These results suggested the following two procedures appropriate for END ; 1) LND for carcinoma of the larynx, hypopharynx or oropharynx, and 2) SOND for that of the tongue & oral floor, with preservation of sternocleidomastoid muscle, accesoty nerve, internal jugular vein and cerical plexus.
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