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Appropriate management of cervical node metastasis is critical in the overall planning and treatment of squamous cell carcinoma of the upper aerodigestive tract. Radical and modified radical neck dissections remain the surgical option for advanced neck disease; however, these procedures are associated with specific complications. In this chapter, we will discuss the history and the development of the radical neck dissection (RND) and modified radical neck dissection (MRND), indications, classifications, and complications and review the management of recurrent neck disease.

Oral cavity squamous cell carcinoma (OCSCC) is diagnosed in over 32,000 patients and associated with over 7000 deaths annually [1]. Despite advances in surgical, reconstructive and adjuvant therapy, 5-year overall survival remains at 60% [2]. Surgical resection of the primary tumor is the standard treatment for local control. Management of the neck traditionally was based on presence of clinical adenopathy (cN+) or clinically negative nodes (cN0). Neck dissection is and remains the standard first line regional therapy for cN+ disease in OCSCC [2]. Over the last 2 decades there has been a transition from the “Halstedian” approach to resection with de-escalation from radical neck dissection to modified radical neck dissection to selective neck dissection without a decrease of regional control and improved functional outcomes and quality of life [3].