The objective of this chapter is to cover discussion on modified radical neck dissection preserving the spinal accessory nerve, the internal jugular vein and the sternocleidomastoid muscle. This operation consists of the en block removal of the lymph node-bearing tissues of one side of the neck, including lymph nodes levels II–V, preserving the spinal accessory nerve, the internal jugular vein (IJV) and the sternocleidomastoid muscle (SCMM). The submandibular and submental triangles may or may not be included in the dissection. The position of the patient on the operating table and the surgical incisions are similar to those recommended for the radical neck dissection. Once the flaps are elevated, depending upon the preference of the surgeon, the dissection may begin in the posterior triangle of the neck, or it may begin superiorly, especially if the submandibular triangle has been dissected.