Pitman et al34 compared 280 patients who underwent 322 MRNDs against 114 patients who underwent 168 SNDs in the clinically N0 neck. These patients had primary tumors of the oral cavity, oropharynx, hypopharynx, and larynx. The overall recurrence rate for the MRNDs was 5.8%, compared with 3.5% for the SNDs. This was not statistically significant, and so the researchers were led to conclude that SNDs are as effective as MRNDs. Clayman and Frank,17 in 1998, reviewed the literature comparing SNDs with MRNDs and elegantly presented arguments for and against SNDs. Recognizing the limitations of retrospective analyses, these researchers concluded that an SND is as effective as an MRND in the elective treatment of clinically N0 necks. Leemans and Snow,35 however, disagree, and combining data of more than 1000 patients who underwent both procedures, they calculated a statistically improved control rate for patients undergoing an MRND. Johnson,18 who believes that MRND may be adequate treatment for selected patients with no more than 2 involved nodes without extracapsular extension, asks, “Is selective neck dissection [alone] adequate therapy for patients with limited occult metastases?” Most of the literature quoted here suggests a tendency to administer adjuvant radiation therapy even in cases of limited microscopic disease in patients undergoing a selective dissection. The Brazilian Head and Neck Cancer Study Group36 published, in 1998, a multi-institutional study of 148 patients with oral cavity cancer who underwent an elective SOHD or MRND. To date, this is the only prospective study comparing these 2 procedures. There were no significant differences in local control and overall survival. In the patients who underwent MRND, metastases to level IV were seen in 5 cases, 2 of which had positive nodes solely at this level. Although the authors conclude that SNDs are oncologically safe, they mention 2 caveats: first, even experienced surgeons were not able to accurately predict occult disease in the neck; second, SNDs should be performed only by experienced head and neck surgeons and not surgeons in training or community surgeons.