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Quick round-up of the neck dissection techniques adopted in head and neck surgeries........* I--Submental and submandibular nodes* II--Upper jugulodigastric group* III--Middle jugular nodes draining the naso- and oropharynx, oral cavity, hypopharynx,larynx.* IV--Inferior jugular nodes draining the hypopharynx, subglottic larynx, thyroid, andesophagus.* V-- Posterior triangle group* VI--Anterior compartment group# Radical Neck Dissection (RND)# Modified Radical Neck Dissection (MRND)# Selective Neck Dissection (SND)For oral cavity cancers, SND (I-III) is commonly performed. For oropharyngeal,hypopharyngeal and laryngeal cancers, SND (II-IV) is the procedure of choice.# Extended Neck DissectionRND with any of the following, nodes--parotid, retropharyngeal, VI node, externalcarotid A, XII nerve, parotid gland, mastoid tipRND------------remove LN I to V, sternocleidomastoid, IGV, spinal accessoryMRND----------remove LN I to V, preserve sternocleidomastoid, IGV, spinal accessory(there are 3 types depending on structure preserved)SND------------anterolateral----I to IIIlateral----------II to IV posterolateral----II to V, along with occipital and post auricular nodesanterior comaprtment--VI
 
Sabiston's Surgery:Radical neck dissection (RND) was described by Crile
in1906 and was considered the gold standard for removal of nodal metastases. Throughclose reading of Crile's later surgical notes, it has been revealed that he had begun tomodify his surgical technique to remove only selected regions of the neck, depending onthe site of the primary tumor. Today, this has become common surgical practice for HNSCC. All modifications of neck dissection are described in relation to the
standard RND, which removes nodal levels I through V,the sternocleidomastoid muscle, the internal jugularvein, cranial nerve XI, the cervical plexus, and thesubmandibular gland.
 
Preservation of thesternocleidomastoid muscle, internal jugular vein, orcranial nerve XI in any combination is referred to as amodified radical neck dissection (MRND)
, and the structures preserved are specified for nomenclature.A
modified neck dissection may also be referred to as aBocca neck dissection
after the surgeon who demonstrated that not only isMRND equally as effective in controlling neck disease as RND when structures are preserved that are not directly involved in tumor but the functional outcomes of patientsafter MRND are also superior to those after RND. Although resection of thesternocleidomastoid muscle or one internal jugular vein is relatively nonmorbid, loss of cranial nerve XI leaves a denervated trapezius muscle, which can cause a painful chronicfrozen shoulder.Either RND or MRND can be performed for removal of detectable nodal disease.
Preservation of any of levels I through V during neck dissection is referred to as selective neck dissection(SND)
and is based on knowledge of the patterns of spread to neck regions.
SND is performed on a clinically negative (N0) neck 
with preservation of nodal groups carrying less than a 20% chance of being involved withmetastatic disease. Regional control has been shown to be as effective after SND as after MRND in patients with a clinically negative neck.Recent studies evaluating treatment of an N0 neck have investigated the use of sentinellymph node biopsy, which attempts to predict the disease status of the neck based on the
 
first echelon of nodes that drain the tumor. Although sentinel lymph node biopsy has beenused extensively with melanoma, its use in HNSCC has come about more gradually.Early results using isosulfan blue dye alone suggested that this technique could notconsistently identify the sentinel node in HNSCC. More recent results using a gamma probe have been more encouraging, although there appears to be a learning curve in theability to identify the node identified as the primary drainage pathway, and sentinellymph node mapping is not currently considered the standard of care. 
Lymphatic drainage Head and Neck 
The lymph nodes of the neck can be divided into six levels within the defined anatomictriangles.The groups and drainage areas are as follows:Level
1
includes the submental and submandibular region. Levels
2
,
3
, and
4
correspond tothe lymph nodes of the jugular chain (ie, high-, mid-, and low-jugular, respectively).Lymph nodes in the posterior triangle and supraclavicular region are located in level
5
.Level
6 
corresponds to the juxtavisceral lymph nodes.
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