Do Pathologic and Molecular Analyses of Neck Dissection Specimens Justify the Preservation of Level IV for Laryngeal Squamous Carcinoma with Clinically Negative Neck?

Abstract

P d I S d t b s s o ince the first detailed description by Franciszek Jawynski in 1888, there have been many variations and odifications of the radical neck dissection procedure. hese include modified radical neck dissection (also alled functional neck dissection) and various selective eck dissections. Analysis of the distribution of lymph node metastases n patients with squamous carcinoma of the larynx reeals a marked preference for levels II, III, and IV; levels and V are rarely involved. Based on these observaions, lateral neck dissection has been recommended in atients with necks staged as N0 or N1. This means emoving the upper jugular lymph nodes (level II), midle jugular lymph nodes (level III), and lower jugular ymph nodes (level IV). Lateral neck dissection is also escribed as jugular node dissection by many surgeons. The need for routine dissection at level IV has reently been questioned. This article discusses whether paring level IV lymph nodes is justified on the strength