Central compartment dissection is defined as the compartment of the neck that includes the precricoid, pretracheal, paratracheal, and perithyroidal nodes, including the nodes along the recurrent laryngeal nerves. The superior boundary of this compartment is the hyoid bone, the inferior boundary is the suprasternal notch and the lateral boundaries are the common carotid arteries. Several classical studies of the distribution of lymphatics of the different areas of the larynx have shown that efferent lymphatics from the subglottic region terminate in the paratracheal lymph nodes or in the prelaryngeal and pretracheal nodes. Dissection of the nodes in the central compartment of the neck is indicated in carcinomas of the thyroid and carcinoma of the larynx. The central compartment dissection may be performed with or without a neck dissection. It can be done before or after the neck dissection is completed. It also differs depending on whether the operation is done for cancer of the thyroid or for cancer of the larynx in conjunction with a total laryngectomy. A detailed description of surgical technique of central compartment dissection with thyroidectomy and total laryngectomy has been presented in this chapter.