The most important prognostic factor in cancers of the head and neck is the status of cervical lymph nodes. The importance of cervical lymph-node metastasis in the management of cancers of the head and neck was reported as early as 1847 by Chelius. Kocher, in the same year, proposed the need to surgically excise these ''glands'' in the treatment of oral cancer. At the turn of the 19th century, Butlin emphasized the need to excise upper cervical lymph nodes in the surgical treatment of tongue cancer. However, the credit for systematic excision of cervical lymph nodes in the surgical treatment of cancers of the head and neck should go to George Crile, Sr., who described the operation of ''radical neck dissection,'' based on his personal experience, in 1906. Hayes Martin popularized the operation and established it as the standard of surgical care for cervical lymph-node metastasis. Although the operation was effective and considered the gold standard, it also caused significant esthetic and functional morbidity.

The authors of this book are to be complimented for putting together an excellent text on the evolution of the philosophy of surgical management of cervical lymph-node metastasis. The concept of cervical lymphatics contained within the fascial compartments of the neck, initially developed and applied to surgical techniques by Osvaldo Suarez, is appropriately credited. Subsequent promulgation of his technique in Europe by Bocca and Gavilan led to the accumulation of significant surgical experience, particularly in cancers of the larynx, to justify the validity of the concept and its surgical application with convincing outcomes. The authors propose ''functional neck dissection'' as a concept and not a modification of the standard radical neck dissection. To that end, the historical perspective detailed in this textbook is impressive.

Understanding of the patterns of cervical lymph-node metastasis has further advanced the ''concept'' of functional neck dissection to the development and clinical applicability of selective neck dissections. Thus, the varieties of selective neck dissections currently in vogue are called extensions of the concept of functional neck dissection, as proposed in this book.

The authors are to be commended for putting together a fine contribution to the literature in the field of head and neck oncology. This book is a classic tour through the history of surgical management of neck metastasis and is a meticulous and outstanding treatise on the technical aspects of the operation. The years of experience amassed by the authors is reflected in the chapter Hints and Pitfalls.

This opus from the surgical dynasty of the Gavilans, enriched by contributions from DeSanto and Herranz, is truly a monumental work on the history, development, practice, and outcomes of functional neck dissection.

Jatin P. Shah, MD, MS (Surg.), FACS Hon. FRCS (Edin.), Hon. FDSRCS (Lond.)

Professor of Surgery Weill Medical College of Cornell University Chief, Head and Neck Service E.W. Strong Chair in Head and Neck Oncology Memorial Sloan-Kettering Cancer Center New York, New York, USA

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