Clinically Negative Neck N0

• controversial management between observation, elective treatment with neck dissection, or radiation therapy

• Observation: may be considered if risk of occult metastasis is

• Elective Neck Dissection: generally indicated if risk of regional metastasis >15-25% (eg, supraglottis, base of tongue, tonsil, oral tongue, and advanced staged cancer), typically a modified neck dissection of selected nodal groups provides the least morbidity with adequate excision, specimen provides histology to evaluate for positive nodes and extracapsular spread (adjuvant therapy)

• Radiation Therapy: may also be considered to eradicate occult neck disease if risk of regional metastasis is >15—25%, indicated especially if primary site is being irradiated

The Fixed Neck (unresectable)

• fixed nodes suggest adherence to the vertebrae, branchial plexus, major vessels, mastoid process, or other structures that are nonmobile

• unresectability is typically considered for branchial plexus, floor of neck, or vertebral involvement (carotid artery involvement is considered a relative contraindication)

• multimodality therapy is offered as an initial radiation and chemotherapy in hopes of "freeing up" the tumor to allow for resection

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