Background: Head and neck carcinomas typically metastasize via the lymphatic system. Surgical removal of cervical lymph nodes (neck dissection) is an essential part of therapy. While radical procedures were historically performed, often resulting in significant functional impairments, current approaches favor selective dissections. The necessity of including lymph node levels IV and V remains under discussion.

Results: Metastases were detected in 93.5% of cases in levels II–III, in 9.3% in level Ia, in 36.1% in level Ib, and in 3.7% in levels IV+V. Occult metastases occurred in four cases. Metastases in levels IV+V were found exclusively in tumors without midline extension. CT sensitivity was 100% for levels Ia, Ib, and IV+V, and 94.9% for levels II–III. However, specificity was very low at 4.2%. In total, 40 major and 50 minor complications were documented, most commonly wound healing disorders (17.6%), flap necroses (10.2%), and cervical hematomas (8.3%).

Conclusion: A negative CT reliably excluded metastases in levels IV+V, whereas positive findings were mostly false positives. Given the complication rate, omission of dissection of levels IV+V may be justified in the case of a negative CT. A selective neck dissection of levels I–III remains indicated.