From the information given thus far, it is obvious that the functional concept and the selective operations are more similar than they appear to be in some classifications. They are both indicated for N0 patients, they both preserve neck structures not involved by the tumor, and they both may be performed simultaneously on both sides of the neck. In fact, functional and selective neck dissections are so similar to each other that they could be regarded as the same thing with different names. It is most important here to understand that the functional concept holds the clue for the oncological safety of all selective neck dissections.
If functional neck dissection is a concept, selective operations are the materialization of this concept. Thus, the functional concept includes in its definition all types of selective neck dissections because they all share the same rationale and indications of the functional approach. The differences between the various selective operations are only technical considerations emerging from a common, standard complete functional neck dissection.
One of the advantages of this conceptual approach to nonradical neck dissection is that it provides the rationale for the oncological safety of selective neck dissections. On the other hand, a conceptual approach like this reduces the relative importance of selective neck dissections, which are now regarded not as different operations, but as technical variations of the original procedure.
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