Thyroid cancer is the third most common solid tumor in children. Childhood thyroid cancer is frequently associated with lymph-node involvement and is a more aggressive entity than in adults. With an estensive surgical treatment the prognostic remains excellent. The extent of initial surgery for an optimal treatment requires total thyroidectomy associated with node dissection of the central compartment and lateral compartment in all patients proved nodes. In selected cases we perform lateral neck dissection approaching the lateral compartment with a less invasive access through a high cervical incison. We approach the lateral compartment without extending the access with prolonged L-shaped incision or adding a separate high incision. This access enables us to dissect lymph nodes of the lateral compartment from the level of the carotid artery bifurcation (level II) to the supraclavear space level IV. The lateral compartment is reached running along the superficial fasciae of the neck, posteriorly to the sternocleidomastoid muscle. This access is totally external to the thyroid space. With this less invasive approach we are able to extent the neck dissection of the lateral compartment from level II to the level IV as well as with the traditional extended approaches.