During a radical neck dissection for metastatic cervical lymphadenopathy, the surgeon removes lymph node levels I-V along with the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve. Which structure, if preserved, would convert this to a modified radical neck dissection rather than a radical neck dissection?

• A Preservation of the submandibular gland
• B Preservation of any one of the sternocleidomastoid muscle, internal jugular vein, or spinal accessory nerve ✓
• C Preservation of the omohyoid muscle
• D Preservation of the thoracic duct on the left side

Explanation

Radical neck dissection removes all five lymph node levels along with the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve. Modified radical neck dissection preserves one or more of these three non-lymphatic structures. Preservation of any single structure (SCM, IJV, or SAN) converts the procedure to modified radical neck dissection. The submandibular gland and omohyoid are not defining structures for this classification.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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Written and medically reviewed by the StethoPrep medical team.