Is routine inclusion of level IV necessary in neck dissection for clinically N0 supraglottic carcinoma?

Elective level II to IV dissection has become a common practice for patients with N0 neck and supraglottic laryngeal carcinoma. Several authors have questioned the necessity of dissecting level IV and the possible risk of associated morbidities such as chyle leak and phrenic nerve injury. We reviewed 58 patients who underwent elective functional and lateral neck dissection for supraglottic carcinoma. Node levels were delineated just after the removal of the specimens. The patients were followed at least 3 years postoperatively or until the time of death; recurrence rates and levels were evaluated. Occult lymph node metastases were determined in 14 cases. Level II was the most involved zone (7 patients). Isolated level IV lymph node metastasis was not established. We think that routine level IV dissection is not necessary in the management of clinically and radiologically N0 necks in patients with supraglottic laryngeal carcinoma.