title: Routine inclusion of level IV in neck dissection for squamous cell carcinoma of the larynx: is it justified?
abstract: BACKGROUND
  Dissection of levels II-IV as part of an elective or therapeutic neck dissection is common practice during laryngectomy for laryngeal squamous cell carcinoma (SCC). The necessity of routine dissection at level IV has recently been questioned. The purpose of this study was to find the incidence of level IV metastases in patients with transglottic and supraglottic SCC who underwent neck dissections.
  
  
  METHODS
  The charts of 71 suitable patients were reviewed. Forty-two had supraglottic primary cancers, and 29 had transglottic primary tumors. Levels II-IV had been removed in them all, and their neck specimens were marked according to the levels of the neck. The surgical specimens were pathologically diagnosed.
  
  
  RESULTS
  Of 43 patients who underwent elective lateral neck dissection, the only one (2.3%) with level IV metastases also showed metastases at level II. Nine (32%) of the other 28 patients with clinical adenopathy had level IV metastases.
  
  
  CONCLUSIONS
  Dissection of level IV as part of a therapeutic neck dissection for supraglottic and transglottic SCC is recommended for patients with clinically enlarged lymph nodes, but its necessity in the absence of detectable adenopathy is challenged.
authors.affiliation: The Department of Otolaryngology and Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, 6 Weizmann Street, Tel-Aviv, 64239 Israel. khafif@tasmc.health.gov.il
authors.forename: Avi
authors.initials: A
authors.lastname: Khafif
authors.forename: Dan M
authors.initials: DM
authors.lastname: Fliss
authors.forename: Ziv
authors.initials: Z
authors.lastname: Gil
authors.forename: Jesus E
authors.initials: JE
authors.lastname: Medina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*