Level I dissection for laryngeal and hypopharyngeal cancer: is it indicated?

Squamous cell carcinoma of the larynx and hypopharynx tends to metastasize frequently to cervical lymph nodes, the location of which depends mainly on the site of the primary lesion. Five anatomical levels of cervical nodes have consequently been defined to standardize the terminology used to describe which lymph node groups are at risk for metastatic spread. Level I includes the submental and submandibular triangles. This review considers the role of these triangles in neck dissection and concludes that, unless there is clear evidence of spread, the inclusion of the level I triangles in the neck dissection is unwarranted since these nodes are not really at risk. There is therefore an important role for selective neck dissection in suitable cases of squamous cell carcinoma of the larynx and hypopharynx.