Modified and complete neck dissection in the treatment of squamous cell carcinoma of the head and neck.

The relative merits and indications for complete or modified dissection of the neck are straightforward. Which operation is selected centers on the perception of the value of the preservation or the risk with the loss of one or more of three structures: the spinal accessory nerve, the internal jugular vein and the sternocleidomastoid muscle. If these were the only issues, the choice of operation would be easy. Unfortunately, some of the most contentious issues in treatment of metastasis to the neck have been linked with the concept of the modified neck dissection. Such issues as combined multimodality therapy, preoperative and postoperative radiation therapy or surgical treatment alone, prophylactic dissection and bilateral simultaneous dissection of the neck are rightly or wrongly tied in with the type of dissection of the neck. More information, such as the certainty of the real risk factors in the neck with metastatic disease, the real value, if any, of adjunctive combined therapy and basic information about the role of the nodes in the neck, is necessary before the debate on the modified versus the radical dissection of the neck will end.