This is a philosophical rather than a technical issue. Functional neck dissection is based on fascial compartmentalization of the neck. The fascial spaces of the neck separate the lymphatic tissue from the remaining neck structures. As a consequence of this definition, functional neck dissection is not possible in a previously irradiated patient because destruction of the fascial spaces within the neck is one of the unavoidable consequences of radiation therapy. Thus, fascial neck dissection is not possible after radiation to the neck.
According to the clinical scenario, some type of nonradical neck dissection may be possible in previously irradiated patients. However, these operations are not true functional neck dissections but technical modifications to radical neck dissection in which emphasis is placed on preserving selected neck structures not involved by the tumor. These are ''modified radical neck dissections,'' operations based on the principles described by Crile, in which some preservation is attempted.
This situation clearly illustrates the conceptual difference between the functional and the classic approach to neck dissection.
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