Elective treatment of cervical lymph node metastasis is generally recommended when the risk of occult disease is around 15 to 20 percent. Candela and colleagues demonstrated that the nodal groups at risk from laryngeal cancer are at levels II, III and IV.32 Level I was rarely involved in isolation and level V was never involved alone. This tends to support the removal of levels II, III and IV, the so-called jugular node dissection or lateral neck dissection,
for elective neck treatment33 (Figure 9-18). Spiro and colleagues concluded that this dissection should extend at least 2 cm lateral to the jugular vein to adequately sample the nodes at risk.34
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