The variety of cervical lymphadenectomy and neck reconstructive procedures that have been developed in the past 20 years has led to confusion about nomenclature in the literature. In addition, some of these operations result in gross alteration of the normal anatomy. The authors review the present classification system for cervical lymph nodes and various lymphadenectomy and reconstructive procedures. Examples of typical postoperative images are given. A protocol for postoperative follow-up is presented, which calls for imaging for 5 years after surgery. Finally, the authors review their experience with 400 cases, 276 of which were initially classified as having no clinical evidence of disease. Recurrence developed in 68 of these (in 62 [91%] within 4-18 months of surgery). Imaging findings altered the postoperative salvage plan in 17 (25%). Clinically occult disease was found at sectional imaging in 47 (17%).