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Radiotherapy can be given before or after surgery in a combined treatment regime. Each sequence has theoretical advantages and disadvantages. However, the results of the RTOG 73-03 trial and other randomized trials address the advantage of a postoperative radiation treatment. Historically, postoperative radiation was first requested when positive surgical margins were found. The indication was expanded gradually as new prognostic features were identified. Postoperative neck irradiation is now considered indicated in the cases of (a) close or positive margins (b) perineural spread (c) extensive vascular invasion /ECE/ (d) multiple positive nodes (e) extracapsular extension. The available data indicate the multiple nodes and particularly ECE are poor prognostic factors for regional control. Peters et al. found that ECE when present is associated with a crude local-regional failure rate of 26% compared to only 13% when it was absent. The general guideline for timing of radiation in relationship to surgery has been commence treatment when the tissues are well healed. However, the longer the interval the greater the opportunity for the presumed clonogens to proliferate. Good collaboration between surgeons and radiation therapists will enable starting postoperative radiation within 4-6 weeks after surgery. Radiation dose especially for high risk patients should be minimum 60 Gy. The most common side effects are strictures, edema, fistula, severe fibrosis and osteoradionecrosis. A special group of patients will be represented by cases with unknown primary. Postoperative radiation is usually indicated also for the putative primary site. Irradiation to the neck alone is indicated, if the probability of neck recurrence is high but the histology or location indicates a low probability of a primary along the pharyngeal axis or the patient is not expected to tolerate large volume irradiation to the pharyngeal axis. squamous cell carcinoma of the head and neck. Modified neck dissections with preservation of spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle and removal of the lymph nodes (level II-V) were performed in all patients. In 22 neck dissections (group 1) additionally the cervical plexus was preserved, in 23 (group 2) the cervical plexus were sacrificed. Postoperatively the subjects were examined for sensory loss and accessory nerve function and followed for regional recurrence for a minimum of 2,5 years. Results: The group whose cervical plexus were preserved had significantly less sensory loss and a normal function of the spinal accessory nerve in all patients. Three cases of group 2 also had a palsy of the trapezius muscle despite the spinal accessory nerve was preserved. Only one subject in group 2 had a regional recurrence.