Modified Radical Neck Dissection

All patients with a diagnosis of thyroid cancer should have a complete preoperative ultrasound of the central and lateral compartments of the neck, with clear documentation of the description and location of suspicious lymph nodes using the standard nomenclature. Fine needle aspiration biopsy of suspicious lymph nodes should be performed preoperatively in order to guide the extent of surgery. Papillary and medullary thyroid cancers frequently metastasize to the cervical lymph nodes. Thyroid cancer nodal metastases are best treated with formal compartmental clearance. For metastatic thyroid cancer within the lateral neck, the authors perform a formal nodal clearance of levels IIA, III, IV, and VB. The standard nomenclature, preoperative preparation, steps of the dissection, and postoperative care are described.