This is an 11-year retrospective study of 389 patients who underwent 527 supraomohyoid neck dissections in a clinically node-negative (cN0) neck between November 2012 and November 2023. Oropharyngeal, maxillary, gingival and maxillary sinus tumours, along with those with a location posterior to the terminal sulcus of the retromolar trigone, were excluded – as were previous surgery, radiation or chemotherapy. The tumour size was not thought to be relevant. They found no evidence of level IIb lymph nodes in any of the 389 patients with a cN0 neck. They advocated that a supraomohyoid neck dissection without level IIb would not compromise cancer surgery. This would reduce shoulder injury by iatrogenic accessory nerve traction injury when clearing level IIb.