Indications for neck dissection or irradiation in parotid cancers

When neck dissection is indicated and a surgeon lacks the expertise, refer to another centre for neck dissection
Clinically/radiologically apparent cervical metastases: Modified radical neck dissection (Levels 1-5)
Clinically/radiologically N0 neck
- Elective treatment of the neck (Levels 2/3/4) for parotid cancer is controversial
- Elective neck dissection and elective radiotherapy are equally effective
- Known risk factors for occult neck disease are
  - Tumour size >4cm
  - High-grade histology
  - Extraparotid tumour extension
- Always sample nodes in Level 2a at the time of parotidectomy, or perform Level 2 selective neck dissection, to avoid having to redissect Level 2
  - If positive on frozen section, proceed to modified neck dissection
  - If frozen section not available, then histological examination guides subsequent treatment planning
- When performing elective neck dissection (Levels 2/3/4) for skin cancer metastases to the parotid, always include the nodes overlying the sternomastoid along the external jugular vein