From the Guidelines
In radical neck dissection, none of the structures listed in the options are preserved. The correct answer is that none of these structures are preserved during a radical neck dissection. A radical neck dissection involves the complete removal of all lymph nodes from levels I through V, along with the internal jugular vein, sternocleidomastoid muscle, and spinal accessory nerve, as historically classified in procedures for cervical lymph node dissections 1. The submandibular salivary gland and posterior belly of the digastric muscle are also typically removed during this procedure. This extensive surgery is performed primarily for advanced head and neck cancers with significant nodal involvement. Modern approaches have evolved toward modified radical neck dissections that preserve one or more of these structures when oncologically safe, which helps reduce post-operative morbidity, particularly shoulder dysfunction from spinal accessory nerve sacrifice, as noted in the context of mucosal melanoma of the head and neck 1. However, in a true radical neck dissection as classically defined, all these structures are removed to ensure complete clearance of potential metastatic disease. Key points to consider include:
- The classification of cervical lymphadenectomy has moved towards comprehensive or selective neck dissections, with the preservation of certain structures not affecting the classification as comprehensive 1.
- The decision to preserve structures depends on the primary location of the tumor and the involvement of lymph node levels, with the goal of balancing oncologic safety with the reduction of morbidity.