Abstract
The management of the cervical lymph nodes in patients with squamous cell carcinoma of the upper aero-digestive tract has evolved, since the beginning of the 20th century, along with the evolution of the neck dissection. In addition to a historical review of this evolution, this chapter presents a detailed review of two of the key elements that have driven the evolution of the radical neck dissection into several neck dissections, each of which has different indications. These elements are (1) a progressive understanding of the anatomy of the lymphatic drainage of the head and neck region and (2) clinical and histopathological observations of the patterns of lymph node metastases of cancers in the different areas of the upper aero-digestive tract and of the skin of the head and neck. The chapter concludes with a description of the different neck dissections, the nomenclature used to designate them, and the different classification systems that have been proposed to date.