To the Editor The basis of an elective neck dissection was given by Weiss et al1 using a mathematical model, wherein whenever the risk of nodal metastasis was more than 20%, outcomes were poorer and called for a neck dissection.

Warshavsky et al,2 in their meta-analysis and systematic review, have shown that the incidence of an occult nodal metastasis in level IV in cases of oral cancer with clinically node-negative neck cancer was rare. With such low incidence of metastasis to level IV, dissecting and clearing level IV would add to more morbidity and poorer quality of life.