The head and neck encompass some of the most complex anatomical regions in the body, with a high concentration of vital structures in a confined space. Understanding the anatomy and lymphatic system is crucial for comprehending the spread of cancer in the neck region and for successfully performing therapeutic procedures. Most squamous cell carcinomas of the head and neck are at least potentially curable. Primary carcinomas originating in most parts of the head and neck typically metastasize regionally to the cervical lymph nodes. The condition of these lymph nodes is the most important independent prognostic factor in head and neck cancer, making proper management of the cervical lymph nodes crucial for disease control. In fact, in cases where only one lymph node is pathologically positive, the five-year survival rate drops to 50%. Before the revolutionary development of neck dissection, head and neck cancers were considered an inevitably fatal diagnosis. Neck dissection became the standard surgical procedure for removing cancer from regional lymph nodes in the 19th century. The goal is to remove lymph nodes that are affected or at risk of being affected by metastases. Since its inception, neck dissection has undergone numerous modifications. Initially, it was an extremely mutilating procedure that involved removing many structures in the neck, which significantly diminished the quality of life for patients postoperatively. Thanks to the significant efforts of the academic community, neck dissection has evolved over time into a less invasive procedure. Today, the focus is on minimizing the extent of the procedure while maintaining oncological outcomes, leading to the development of selective and superselective dissections. For the future, robotic-assisted and endoscopic procedures are being explored as potential advancements in dissection. Despite progress in oncotherapy, dissection remains one of the main therapeutic modalities for locally advanced disease. In addition to its therapeutic role, dissection is extremely important for staging primary carcinomas, as there is still no sufficiently sensitive technique available to visualize occult metastases in the lymph nodes.