Well, in this instance you have a surgical oriented ENT who is pointing you in another direction. That makes me feel that he thinks that given the tools that HE has, it might be better to work through other therapies first. This seems like a healthy approach. In my own case I had radiation first, and surgery was always a possibility waiting in the wings if the radiation didn't do it all. That was indeed the case, and I had surgery after the radiation to remove additional suspect tissues and nodes. A mandilectomy is a serious procedure with long term surgical and prosthetic rehabilitation issues. I believe that he thinks that this procedure might be avoided if the other treatments do their jobs. I cannot know what he is thinking exactly, but this seems likely. It may still be where your husband has to go, but in this particular instance, if it were me, I would opt to keep my mandible intact at least for the duration of the radiation to see what the results were from that. As to doing a neck dissection, that will probably come down the road as well. No doctor wants to run the risk of having a positive node left behind that will lead you to a distant metastasis sometime in the future. However a neck dissection USUALLY does not include the removal of any portion of the mandible. So you may be a little confused as to what his intentions were/are. The unfortunate term