The extent of neck dissection (ND) for treatment of head and neck cancer has been an area of active research and changes in clinical practice for the last several decades. Radical NDs have largely been replaced by modified and selective NDs.1 The classic neck levels at risk for oral cavity cancers are levels I through III; elective dissection of these levels with a supraomohyoid neck dissection (SOHND) is recommended for many patients with clinical node-negative (cN0) oral cavity cancers given the risk of occult nodal disease.1,2 However, many authors, including Byers and colleagues,3 have suggested that SOHND is inadequate and that level IV should be included owing to the risk of skip metastasis from oral cavity cancer.