ABSTRACT
Many of the surgical principles described in this chapter have not changed significantly since 1906 when Crile published his classic paper describing 132 neck dissections. Only 2 years later, Sir Henry Butlin described a procedure that is essentially the same as a current supra-omohyoid neck dissection. Despite this publication of a ‘selective’ neck dissection, most elective treatment of even the clinically negative neck during the first half of the 20th century consisted mainly of radical neck dissection. The rationale for neck dissection is based on predictable patterns of lymphatic spread from the primary tumour site, and the relative risk of nodal metastatic disease. For all neck dissections, the fully anaesthetised (but unparalysed) patient should be placed supine on the operating table with the head turned away from the side being operated. It is usual to raise skin flaps in a subplatysmal plane. Local anaesthetic solution may be injected to facilitate this process.
