Indications for selective neck dissection: when, how, and why.

Selective neck dissection is a procedure that is primarily indicated in patients with clinically negative nodal disease in which there is a high risk of occult metastases. Others have advocated its use for patients with positive nodes, although under very specific circumstances and in combination with postoperative radiation therapy. The type of selective neck dissection performed varies according to the site of the primary, because the pattern of metastases is unique in each case. This review presents the author's philosophy on when, how, and why to employ the procedure, based on the location of primary cancers at oral, pharyngeal, laryngeal, cutaneous, thyroid, and salivary gland sites.