To highlight the strategy of neck dissection for various subsites of oral squamous cell carcinoma.
Materials & Methodology
Retrospective study of 153 patients with 164 neck dissection was involved between 2010 and 2016. Predictor variables were patient demographics, biopsy reports, imaging assessment and outcome variables were type of neck dissection and reconstruction performed and histological assessment of regional metastasis to the neck in relation to various primary subsites was carried out.
Out of 153 patients, 126 (82.3%) were males and 27 (17.6%) were females with male-to-female ratio being 4.6:1. The mean age among the patients was 49.9 which ranged from 20 to 80 years. Lymph node metastasis was found in 22.6% of T1 and T2 tumors and 77.4% of T3 and T4 tumors. Incidence for gingivobuccal sulcus accounted for 49.6% of primary sites, tongue and floor of the mouth for 15.2%, retromolar trigone for 11.7%, lower alveolus for 8.6%, upper alveolus for 5.9%, lower lip for 3.9%, buccal mucosa for 3.3% and hard palate for 2.6%. Histologically metastasis was seen in level Ib (46%), IIa (33.1%) followed by others. Level V involvement was seen only in 5.5%.
For all subsites for N0 neck, minimum level III clearance should be performed, and for positive neck in RMT region, level IV or level V clearance is warranted. Apart from subsite, other factors to be considered are tumor stage, tumor thickness (DOI) and morphological characteristics of the primary tumor. The role of lymph node metastasis, number, size, extracapsular spread, its proximity and fixity to greater vessels in the neck.
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Li X, Shen Y, Di B and Song Q (2012) Metastasis of head and neck squamous cell carcinoma. Intech. ISBN: 978-953-51-0024-9
Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics. J Cancer Res Clin Oncol 55(2):74–108
Warnakulasuriya S (2009) Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 45(4–5):309–316
Shah J (1990) Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg 160(4):405–409
Snow G, Annyasa A, Slooten E, Bartelink H, Hart A (1982) Prognostic factors of neck node metastasis. Clin Otolaryngol 7(3):185–192
Som P (1987) Lymph nodes of the neck. Radiology 165(3):593–600
Van den Brekel M, Leemans C, Snow G (1996) Assessment and management of lymph node metastases in the neck in head and neck cancer patients. Crit Rev Oncol Hematol 22(3):175–182
Sharpe D (1981) The pattern of lymph node metastases in intra-oral squamous cell carcinoma. Br J Plast Surg 34(1):97–101
Wang Y, Ow T, Myers J (2011) Pathways for cervical metastasis in malignant neoplasms of the head and neck region. Clin Anat 25(1):54–71
Shah J, Candela F, Poddar A (1990) The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity. Cancer 66(1):109–113
Lindberg R (1972) Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tracts. Cancer 29(6):1446–1449
Pandey M, Shukla M, Nithya C (2011) Pattern of lymphatic spread from carcinoma of the buccal mucosa and its implication for less than radical surgery. J Oral Maxillofac Surg 69(2):340–345
Nithya C, Pandey M, Naik B, Ahamed I (2003) Patterns of cervical metastasis from carcinoma of the oral tongue. World J Surg Oncol 1(1):10
Woolgar J (1997) Detailed topography of cervical lymph-node metastases from oral squamous cell carcinoma. Int J Oral Maxillofac Surg 26(1):3–9
Zhang W, Peng X (2016) Cervical metastases of oral maxillary squamous cell carcinoma: a systematic review and meta-analysis. Head Neck 38(S1):E2335–E2342
Califano L, Zupi A, Massari P, Giardino C (1994) Lymph-node metastasis in squamous cell carcinoma of the lip. Int J Oral Maxillofac Surg 23(6):351–355
Narendra H, Tankshali R (2010) Prevalence and pattern of nodal metastasis in pT4 gingivobuccal cancers and its implications for treatment. Indian J Cancer 47(3):328
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Yadav, V.S., Anehosur, V.S.R., Adirajaiah, S. et al. Is Site-Specific Assessment of Neck Nodes Relevant for Neck Dissection. J. Maxillofac. Oral Surg. 20, 566–572 (2021). https://doi.org/10.1007/s12663-020-01495-9