Modified Radical Neck Dissection for Cervical Metastasis

Radical neck dissection (RND) has stood as the cornerstone surgical procedure for managing controlled cervical metastatic disease for over a century. This comprehensive intervention involves the en bloc resection of the tissue contents within the major cervical triangles, bounded by the deep muscular layer and the investing cervical fascia. The anatomical boundaries extend from the inferior border of the mandible superiorly to the clavicle inferiorly, and from the midline anteriorly to the anterior border of the trapezius muscle posteriorly. A standard RND specimen systematically incorporates the sternocleidomastoid muscle (SCM), the internal jugular vein (IJV), the spinal accessory nerve (CN XI), and the lymphatic tissue encompassing levels I through V. However, evolving surgical practice often favors a modified Radical neck dissection (MRND) approach, which preserves non-lymphatic structures such as the IJV and CN XI when not overtly involved by disease, to minimize functional morbidity without compromising oncologic efficacy. This video article delineates a meticulous, step-by-step protocol for performing a radical or modified radical neck dissection, emphasizing critical technical nuances for achieving complete oncologic resection, preserving vital neurovascular structures-including the marginal mandibular nerve, vagus nerve, and phrenic nerve-and undertaking functional reconstruction. Key advantages of our protocol, demonstrated through a representative case, include a high rate of successful nodal clearance, a minimal postoperative complication profile (e.g., <5% rate of chyle leak or major hematoma), and excellent functional outcomes in shoulder abduction and facial symmetry due to precise nerve preservation techniques. This procedural demonstration serves as a valuable educational resource for surgeons mastering this complex and widely performed operation in head and neck oncology.