The Heritage of the Radical Neck Dissection

Abstract

THE SUCCESS of the modern head and neck oncological surgeon in curing patients with head and neck cancer is due in large part to the principles that evolved from the astute clinical observations of George Crile, MD, and the truly imaginative and bold surgical concepts that he fostered. In his monumental article published in JAMA in 1906, he demonstrated the effectiveness of en bloc resection of regional lymph nodes and other lymphatic structures in the neck, including resection of the sternocleidomastoid muscle, the internal jugular vein, and the submaxillary salivary gland, in rendering patients free of disease. What led Crile to the surgical concepts he advocated was his observation that patients with head and neck cancer died primarily because the site of origin of the tumor was not controlled and/or the cancer had spread to regional neck structures. His basic premise was that each patient with cancer of the head