Lee -- We have similar problems, with yours being tonsil and mine BOT. The primary and the nodes were well differentiated in my case. The only other difference is the order of treatment.

The James Cancer Hospital in Columbus is where I am being treated. They suggested an aggressive treatment protocol, beginning with the neck dissection. Their rationale was that a)It enables them to get a better histological picture of the lymph node situation, which can impact rad/chemo program, and b)has fewer surgical complications. However, I have heard equally strong arguments for the other order.

I start my chemo/rad program in 10 days. My mindset is that whatever the docs say, goes, as long as it is reasonably consistent with what I have seen and read. The James is a very highly regarded Center, so I figure I can't be in much better hands.

If I were in your shoes, I would have the ND. The recovery is really not bad, and the peace of mind and extra layer of protection is worth a lot.

You can email me offline if you want to bat this around further. Good luck, whatever you decide!