Oral Cancer Overview: The Significance of Metastasis and Surgical Management of the Neck

  • Eugene N. Myers


Squamous cell carcinoma of the oral cavity has the propensity to metastasize to the cervical lymph nodes even in the early stages. The presence of lymph node metastasis is the most significant independent variable in determining survival of patients with cancer of the head and neck. Therefore, the diagnosis and management of cervical lymph node metastasis is one of the most important responsibilities of the head and neck oncologist.

The management of the neck in patients with cancer of the oral cavity has gone through several cycles. Initially, it was thought that the removal of the primary cancer from the oral cavity without paying attention to the neck was sufficient. However, this policy of “waiting and watching the neck” resulted in approximately one-third of the patients developing recurrence in the neck; some of these recurrences were not operable, and therefore, the majority of these patients died of their cancer.

Neck dissection has evolved from radical neck dissection for patients with clinically detectable disease in the neck to selective neck dissection for patients who have N0 or N+ neck and a “super”-selective neck dissection for patients who have persistent disease following chemoradiation. Although the use of the selective neck dissection in patients with an N0 neck has not improved the cure rate, it has had a major positive impact on regional disease-free survival and has decreased the morbidity associated with surgical management of the neck.

The evolution of the neck dissection and its current use in the management of patients with cancer of the oral cavity are the subject of this chapter.


Oral Cavity Neck Dissection Cervical Lymph Node Cervical Lymph Node Metastasis Radical Neck Dissection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Akhtar S, Ikram M, Ghaffar S (2007) Neck involvement in early carcinoma of tongue. Is elective neck dissection warranted? J Pak Med Assoc 57:305–307PubMedGoogle Scholar
  2. Alvi A, Johnson JT (1996) Extracapsular spread in the clinically negative neck (N0): implications and outcome. Otolaryngol Head Neck Surg 114:65–70CrossRefPubMedGoogle Scholar
  3. Ambrosch P, Brinck U (1996) Detection of nodal micrometastases in head and neck cancer by serial sectioning and immunostaining. Oncology (Williston Park) 10:1221–1226 discussion 1226, 1229Google Scholar
  4. Ambrosch P, Kron M, Fischer G, Brinck U (1995) Micrometastases in carcinoma of the upper aerodigestive tract: detection, risk of metastasizing, and prognostic value of depth of invasion. Head Neck 17:473–479CrossRefPubMedGoogle Scholar
  5. Ambrosch P, Kron M, Pradier O, Steiner W (2001) Efficacy of selective neck dissection: a review of 503 cases of elective and therapeutic treatment of the neck in squamous cell carcinoma of the upper aerodigestive tract. Otolaryngol Head Neck Surg 124:180–187CrossRefPubMedGoogle Scholar
  6. Andersen PE, Warren F, Spiro J, Burningham A, Wong R, Wax MK, Shah JP, Cohen JI (2002) Results of selective neck dissection in management of the node-positive neck. Arch Otolaryngol Head Neck Surg 128:1180–1184PubMedGoogle Scholar
  7. Bennett JA, Deol P, Abrahams JJ (2007) Imaging of patients with oral cancer. In: Werning JW (ed) Oral Cancer. Diagnosis, Management, and Rehabilitation. Thieme Medical Publishers, New YorkGoogle Scholar
  8. Bernier J, Ozsahin M, Greiner R et al (2001) Results of EORTC Phase III Trial 22931 comparing, in post-operative setting, radiotherapy and radiotherapy combined to cisplatin in locally advanced head and neck squamous cell carcinoma (abstract). Int J Radiat Oncol Biol Phys 51(Suppl 1):3Google Scholar
  9. Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945–1952CrossRefPubMedGoogle Scholar
  10. Bocca E (1975) Conservative neck dissection. Laryngoscope 85(9):1511–1515CrossRefPubMedGoogle Scholar
  11. Bocca E, Pignataro O (1967) A conservation technique in radical neck dissection. Ann Otol Rhinol Laryngol 76(5):975–987PubMedGoogle Scholar
  12. Butlin HT (1885) Diseases of the Tongue. Cassell and Company, LondonGoogle Scholar
  13. Byers RM (1985) Modified neck dissection. A study of 967 cases from 1970 to 1980. Am J Surg 150(4):414–421CrossRefPubMedGoogle Scholar
  14. Byers RM, Clayman GL, McGill D, Andrews T, Kare RP, Roberts DB, Goepfert H (1999) Selective neck dissections for squamous carcinoma of the upper aerodigestive tract: patterns of regional failure. Head Neck 21(6):499–505CrossRefPubMedGoogle Scholar
  15. Byers RM, Weber RS, Andrews T, McGill D, Kare R, Wolf P (1997) Frequency and therapeutic implications of “skip metastases” in the neck from squamous carcinoma of the oral tongue. Head Neck 19(1):14–19CrossRefPubMedGoogle Scholar
  16. Byers RM, Wolf PF, Ballantyne AJ (1988) Rationale for elective modified neck dissection. Head Neck Surg 10(3):160–167CrossRefPubMedGoogle Scholar
  17. Cachin Y (1977) Treatment of cervical lymph node metastases from carcinomas of the upper respiratory and digestive tracts. Recent Results Cancer Res 62:215–219PubMedGoogle Scholar
  18. Chelius JM (1847) A System of Surgery. Lea and Blanchard, PhiladelphiaGoogle Scholar
  19. Chen AY, Myers JN (2001) Cancer of the oral cavity. Dis Mon 47(7):275–361CrossRefPubMedGoogle Scholar
  20. Chen AY, Schrag NM, Halpern M, Stewart A, Ward EM (2007) Health insurance and stage at diagnosis of laryngeal cancer: does insurance type predict stage at diagnosis? Arch Otolaryngol Head Neck Surg 133(8):784–790CrossRefPubMedGoogle Scholar
  21. Chepeha DB, Hoff PT, Taylor RJ, Bradford CR, Teknos TN, Esclamado RM (2002) Selective neck dissection for the treatment of neck metastasis from squamous cell carcinoma of the head and neck. Laryngoscope 112(3):434–438CrossRefPubMedGoogle Scholar
  22. Clark J, Li W, Smith G, Shannon K, Clifford A, McNeil E, Gao K, Jackson M, Mo Tin M, O’Brien C (2005) Outcome of treatment for advanced cervical metastatic squamous cell carcinoma. Head Neck 27(2):87–94CrossRefPubMedGoogle Scholar
  23. Conley J (1967) Cancer of the Head and Neck. Proceedings of the International Workshop on CANCER of the HEAD and NECK. Butterworths, WashingtonGoogle Scholar
  24. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350(19):1937–1944CrossRefPubMedGoogle Scholar
  25. Crile GW (1905) On the surgical treatment of cancer of the head and neck. With a summary of one hundred and twenty-one operations performed upon one hundred and five patients. Trans South Surg Gynecol Assoc 18:108–127Google Scholar
  26. Crile GW (1906) Excision of cancer of the head and neck. With special reference to the plan of dissection based on one hundred and thirty-two operations. JAMA 47:1780–1786Google Scholar
  27. Cunningham MJ, Johnson JT, Myers EN, Schramm VL Jr, Thearle PB (1986) Cervical lymph node metastasis after local excision of early squamous cell carcinoma of the oral cavity. Am J Surg 152(4):361–366CrossRefPubMedGoogle Scholar
  28. Enepekides DJ, Sultanem K, Nguyen C, Shenouda G, Black MJ, Rochon L (1999) Occult cervical metastases: immunoperoxidase analysis of the pathologically negative neck. Otolaryngol Head Neck Surg 120(5):713–717CrossRefPubMedGoogle Scholar
  29. Ferlito A, Rinaldo A (2005) Neck dissection: historical and current concepts. Am J Otolaryngology – Head and Neck Medicine and Surgery 26:289–295Google Scholar
  30. Ferlito A, Johnson JT, Rinaldo A, Pratt LW, Fagan JJ, Weir N, Suarez C, Folz BJ, Bien S, Towpik E, Leemans CR, Bradley PJ, Kowalski LP, Herranz J, Gavilan J, Olofsson J (2007) European surgeons were the first to perform neck dissection. Laryngoscope 117(5):797–802CrossRefPubMedGoogle Scholar
  31. Ferlito A, Rinaldo A (2004) Osvaldo Suarez: often-forgotten father of functional neck dissection. Laryngoscope 114(7):1177–1178CrossRefPubMedGoogle Scholar
  32. Funk GF, Karnell LH, Robinson RA, Zhen WK, Trask DK, Hoffman HT (2002) Presentation, treatment, and outcome of oral cavity cancer: a National Cancer Data Base report. Head Neck 24(2):165–180CrossRefPubMedGoogle Scholar
  33. Gavilan J, Herranz-Gonzalez JJ, Lentsch EJ (2003) Cancer of the Neck. In: Myers EN, Suen JY, Myers JN, Hanna EYN (eds) Cancer of the Head and Neck. Saunders, PhiladelphiaGoogle Scholar
  34. Goodwin WJ, Thomas GR, Parker DF, Joseph D, Levis S, Franzmann E, Anello C, Hu JJ (2008) Unequal burden of head and neck cancer in the United States. Head Neck 30(3):358–371CrossRefPubMedGoogle Scholar
  35. Greenberg JS, Fowler R, Gomez J, Mo V, Roberts D, El Naggar AK, Myers JN (2003) Extent of extracapsular spread: a critical prognosticator in oral tongue cancer. Cancer 97(6):1464–1470CrossRefPubMedGoogle Scholar
  36. Greenlee RT, Murray T, Bolden S, Wingo PA (2000) Cancer statistics. CA Cancer J Clin 50:7–33CrossRefPubMedGoogle Scholar
  37. Group, Brazilian Head and Neck Cancer Study (1999) End results of a prospective trial on elective lateral neck dissection vs. type III modified radical neck dissection in the management of supraglottic and transglottic carcinomas. Head Neck 21(8):694–702CrossRefGoogle Scholar
  38. Hamakawa H, Takemura K, Sumida T, Kayahara H, Tanioka H, Sogawa K (2000) Histological study on pN upgrading of oral cancer. Virchows Arch 437:116–121CrossRefPubMedGoogle Scholar
  39. Hao SP, Tsang NM (2002) The role of supraomohyoid neck dissection in patients with oral cavity carcinoma. Oral Oncol 38(3):309–312CrossRefPubMedGoogle Scholar
  40. Hart RD, Henry E, Nasser JG, Trites JR, Taylor SM, Bullock M, Barnes D (2007) Sentinel node biopsy in N0 squamous cell carcinoma of the oral cavity and oropharynx in patients previously treated with surgery or radiation therapy: a pilot study. Arch Otolaryngol Head Neck Surg 133(8):806–809Google Scholar
  41. Henick DH, Silver CE, Heller KS, Shaha AR, El GH, Wolk DP (1995) Supraomohyoid neck dissection as a staging procedure for squamous cell carcinomas of the oral cavity and oropharynx. Head Neck 17(2):119–123CrossRefPubMedGoogle Scholar
  42. Hinerman RW, Mendenhall WM, Morris CG, Amdur RJ, Werning JW, Villaret DB (2004) Postoperative irradiation for squamous cell carcinoma of the oral cavity: 35-year experience. Head Neck 26(11):984–994CrossRefPubMedGoogle Scholar
  43. Hollenbeak CS, Lowe VJ, Stack BC Jr (2001) The cost-effectiveness of fluorodeoxyglucose 18-F positron emission tomography in the N0 neck. Cancer 92(9):2341–2348CrossRefPubMedGoogle Scholar
  44. Hosal AS, Carrau RL, Johnson JT, Myers EN (2000) Selective neck dissection in the management of the clinically node-negative neck. Laryngoscope 110(12):2037–2040CrossRefPubMedGoogle Scholar
  45. Jawdynski F (1888) Przypadek raka pierwotnego szyi. t.z. raka skrzelowego Volkmann’a. Wyciecie nowotworu wraz z rezekcyja tetnicy szyjowej wspolney i zyly szyjowej wewnetrznej. Wyzdrowienie Gaz Lek 8:530–537Google Scholar
  46. Johnson JT, Barnes EL, Myers EN, Schramm VL Jr, Borochovitz D, Sigler BA (1981) The extracapsular spread of tumors in cervical node metastasis. Arch Otolaryngol 107(12):725–729PubMedGoogle Scholar
  47. Johnson JT, Myers EN, Bedetti CD, Barnes EL, Schramm VL Jr, Thearle PB (1985) Cervical lymph node metastases. Incidence and implications of extracapsular carcinoma. Arch Otolaryngol 111(8):534–537PubMedGoogle Scholar
  48. Johnson JT, Myers EN, Schramm VL Jr, Mayernik DG, Nolan TA, Sigler BA, Wagner RL (1987) Adjuvant chemotherapy for high-risk squamous-cell carcinoma of the head and neck. J Clin Oncol 5(3):456–458PubMedGoogle Scholar
  49. Johnson JT, Wagner RL, Myers EN (1996) A long-term assessment of adjuvant chemotherapy on outcome of patients with extracapsular spread of cervical metastases from squamous carcinoma of the head and neck. Cancer 77(1):181–185CrossRefPubMedGoogle Scholar
  50. Khafif A, Lopez-Garza JR, Medina JE (2001) Is dissection of level IV necessary in patients with T1–T3 N0 tongue cancer? Laryngoscope 111(6):1088–1090CrossRefPubMedGoogle Scholar
  51. Klein R (1996) Where there’s smoke, there’s.. In: Hutcheon L, Hutcheon M (eds) Opera. Desire. Disease. Death. University of Nebraska Press, Lincoln & LondonGoogle Scholar
  52. Kligerman J, Lima RA, Soares JR, Prado L, Dias FL, Freitas EQ, Olivatto LO (1994) Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg 168(5):391–394CrossRefPubMedGoogle Scholar
  53. Koch BB, Trask DK, Hoffman HT, Karnell LH, Robinson RA, Zhen W, Menck HR (2001) National survey of head and neck verrucous carcinoma: patterns of presentation, care, and outcome. Cancer 92(1):110–120CrossRefPubMedGoogle Scholar
  54. Kocher T (1880) Radicalheilung des Krebses. Dtsch Z Chir 13:134–166Google Scholar
  55. Kowalski LP, Bagietto R, Lara JR, Santos RL, Silva JF Jr, Magrin J (2000) Prognostic significance of the distribution of neck node metastasis from oral carcinoma. Head Neck 22(3):207–214CrossRefPubMedGoogle Scholar
  56. Kurokawa H, Yamashita Y, Takeda S, Zhang M, Fukuyama H, Takahashi T (2002) Risk factors for late cervical lymph node metastases in patients with stage I or II carcinoma of the tongue. Head Neck 24(8):731–736CrossRefPubMedGoogle Scholar
  57. Lim SC, Zhang S, Ishii G, Endoh Y, Kodama K, Miyamoto S, Hayashi R, Ebihara S, Cho JS, Ochiai A (2004) Predictive markers for late cervical metastasis in stage I and II invasive squamous cell carcinoma of the oral tongue. Clin Cancer Res 10(1 Pt 1):166–172CrossRefPubMedGoogle Scholar
  58. Lingeman RE, Helmus C, Stephens R, Ulm J (1977) Neck dissection: radical or conservative. Ann Otol Rhinol Laryngol 86(6 Pt 1):737–744PubMedGoogle Scholar
  59. Lohuis PJ, Klop WM, Tan IB, van Den Brekel MW, Hilgers FJ, Balm AJ (2004) Effectiveness of therapeutic (N1, N2) selective neck dissection (levels II to V) in patients with laryngeal and hypopharyngeal squamous cell carcinoma. Am J Surg 187(2):295–299CrossRefPubMedGoogle Scholar
  60. Martin HE, Del Valle B, Ehrlich H et al (1951) Neck dissection. Cancer 4:441–499CrossRefPubMedGoogle Scholar
  61. Medina JE, Byers RM (1989) Supraomohyoid neck dissection: rationale, indications, and surgical technique. Head Neck 11(2):111–122CrossRefPubMedGoogle Scholar
  62. Molinari R, Cantu G, Chiesa F, Grandi C (1980) Retrospective comparison of conservative and radical neck dissection in laryngeal cancer. Ann Otol Rhinol Laryngol 89:578–581PubMedGoogle Scholar
  63. Muzaffar K (2003) Therapeutic selective neck dissection: a 25-year review. Laryngoscope 113(9):1460–1465CrossRefPubMedGoogle Scholar
  64. Myers EN (2008) Operative Otolaryngology-Head and Neck Surgery. 2nd Ed., Saunders, PhiladelphiaGoogle Scholar
  65. Myers EN, Simental AA (2003) Cancer of the Oral Cavity. In: Myers EN, Suen JY, Myers JN, Hanna EYN (eds) Cancer of the Head and Neck. Saunders, PhiladelphiaGoogle Scholar
  66. Myers EN, Gastman BR (2003) Neck dissection: an operation in evolution. Arch Otolaryngol Head Neck Surg 129(1):14–25CrossRefPubMedGoogle Scholar
  67. Myers JN, Elkins T, Roberts D, Byers RM (2000) Squamous cell carcinoma of the tongue in young adults: increasing incidence and factors that predict treatment outcomes. Otolaryngol Head Neck Surg 122(1):44–51CrossRefPubMedGoogle Scholar
  68. Myers JN, Greenberg JS, Mo V, Roberts D (2001) Extracapsular spread. A significant predictor of treatment failure in patients with squamous cell carcinoma of the tongue. Cancer 92(12):3030–3036CrossRefPubMedGoogle Scholar
  69. Ocharoenrat P, Pillai G, Patel S, Fisher C, Archer D, Eccles S, RhysEvans P (2003) Tumour thickness predicts cervical nodal metastases and survival in early oral tongue cancer. Oral Oncol 39:386–390CrossRefGoogle Scholar
  70. Packard JH (1881) A system of surgery, theoretical and practical. In: Holmes ET (ed) In treatises by various authors. 1st American, from the 2d English ed. thoroughly revised and much enlarged. H C Lea’s Son & Co, PhiladelphiaGoogle Scholar
  71. Paleri V, Kumar Subramaniam S, Oozeer N, Rees G, Krishnan S (2008) Dissection of the submuscular recess (sublevel IIb) in squamous cell cancer of the upper aerodigestive tract: Prospective study and systematic review of the literature. Head Neck 30(2):194–200CrossRefPubMedGoogle Scholar
  72. Pellitteri PK, Robbins KT, Neuman T (1997) Expanded application of selective neck dissection with regard to nodal status. Head Neck 19(4):260–265CrossRefPubMedGoogle Scholar
  73. Pitman KT, Johnson JT, Myers EN (1997) Effectiveness of selective neck dissection for management of the clinically negative neck. Arch Otolaryngol Head Neck Surg 123(9):917–922PubMedGoogle Scholar
  74. Rigual N, Douglas W, Lamonica D, Wiseman S, Cheney R, Hicks W Jr, Loree T (2005) Sentinel lymph node biopsy: a rational approach for staging T2N0 oral cancer. Laryngoscope 115(12):2217–2220CrossRefPubMedGoogle Scholar
  75. Robbins KT (2001) Pocket Guide to Neck Disection Classification and TNM Staging o Head and Neck Cancer, 2nd edn. American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, VAGoogle Scholar
  76. Robbins KT, Doweck I, Samant S, Vieira F (2008a) Effectiveness of superselective and selective neck dissection for advanced nodal metastases after chemoradiation. Arch Otolaryngol Head Neck Surg 131:965–969CrossRefGoogle Scholar
  77. Robbins KT, Shaha AR, Medina JE, Califano JA, Wolf GT, Ferlito A, Som PM, Day TA, Committee for Neck Dissection Classification, American Head and Neck Society (2008b) Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg 134(5):536–538CrossRefPubMedGoogle Scholar
  78. Ross GL, Soutar DS, Gordon MacDonald D, Shoaib T, Camilleri I, Roberton AG, Sorensen JA, Thomsen J, Grupe P, Alvarez J, Barbier L, Santamaria J, Poli T, Massarelli O, Sesenna E, Kovacs AF, Grunwald F, Barzan L, Sulfaro S, Alberti F (2004) Sentinel node biopsy in head and neck cancer: preliminary results of a multicenter trial. Ann Surg Oncol 11(7):690–696CrossRefPubMedGoogle Scholar
  79. Rouviere H (1932) Anatomie des lymphatiques de l’homme. Mason et cie, ParisGoogle Scholar
  80. Schramm VL Jr, Myers EN, Sigler BA (1980) Surgical management of early epidermoid carcinoma of the anterior floor of the mouth. Laryngoscope 90(2):207–215CrossRefPubMedGoogle Scholar
  81. Shah JP (1990) Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg 160:405–409CrossRefPubMedGoogle Scholar
  82. Simental AA Jr, Duvvuri U, Johnson JT, Myers EN (2006) Selective neck dissection in patients with upper aerodigestive tract cancer with clinically positive nodal disease. Ann Otol Rhinol Laryngol 115(11):846–849PubMedGoogle Scholar
  83. Snow GB, Annyas AA, van Slooten EA, Bartelink H, Hart AA (1982) Prognostic factors of neck node metastasis. Clin Otolaryngol Allied Sci 7(3):185–192CrossRefPubMedGoogle Scholar
  84. Sparano A, Weinstein G, Chalian A, Yodul M, Weber R (2004) Multivariate predictors of occult neck metastasis in early oral tongue cancer. Otolaryngol Head Neck Surg 131(4):472–476CrossRefPubMedGoogle Scholar
  85. Spiro JD, Spiro RH, Shah JP, Sessions RB, Strong EW (1988) Critical assessment of supra­omohyoid neck dissection. Am J Surg 156(4):286–289CrossRefPubMedGoogle Scholar
  86. Spiro RH, Gallo O, Shah JP (1993) Selective jugular node dissection in patients with squamous carcinoma of the larynx or pharynx. Am J Surg 166(4):399–402CrossRefPubMedGoogle Scholar
  87. Spiro RH, Morgan GJ, Strong EW, Shah JP (1996) Supraomohyoid neck dissection. Am J Surg 172(6):650–653CrossRefPubMedGoogle Scholar
  88. Stoeckli SJ (2007) Sentinel node biopsy for oral and oropharyngeal squamous cell carcinoma of the head and neck. Laryngoscope 117(9):1539–1551CrossRefPubMedGoogle Scholar
  89. Stoeckli SJ, Pfaltz M, Ross GL, Steinert HC, MacDonald DG, Wittekind C, Soutar DS (2005) The second international conference on sentinel node biopsy in mucosal head and neck cancer. Ann Surg Oncol 12(11):919–924CrossRefPubMedGoogle Scholar
  90. Traynor SJ, Cohen JI, Gray J, Andersen PE, Everts EC (1996) Selective neck dissection and the management of the node-positive neck. Am J Surg 172(6):654–657CrossRefPubMedGoogle Scholar
  91. Trotter HA (1930) The surgical anatomy of the lymphatics of the head and neck. Ann Otol Rhinol Laryngol 39:384–397Google Scholar
  92. Werning JW, Mendenhall WM (2007) Management of the neck. In: Werning JW (ed) Oral cancer. Diagnosis, management, and rehabilitation. Thieme Medical Publishers, New YorkGoogle Scholar
  93. Werning JW, Heard D, Pagano C, Khuder S (2003) Elective management of the clinically negative neck by otolaryngologists in patients with oral tongue cancer. Arch Otolaryngol Head Neck Surg 129(1):83–88CrossRefPubMedGoogle Scholar
  94. Wolfensberger M, Zbaeren P, Dulguerov P, Müller W, Ornoux A, Schmid, S (2001) Surgical treatment of early oral carcinoma–Results of a prospective controlled multi center study, Head and Neck 23:525–530Google Scholar
  95. Yuen AP, Lam KY, Lam LK, Ho CM, Wong A, Chow TL, Yuen WF, Wei WI (2002) Prognostic factors of clinically stage I and II oral tongue carcinoma. A comparative study of stage, thickness, shape, growth pattern, invasive front malignancy grading, Martinez-Gimeno score, and pathologic features. Head Neck 24:513–520CrossRefPubMedGoogle Scholar
  96. Yuen AP, Lam KY, Wei WI, Lam KY, Ho CM, Chow TL, Yuen WF (2000) A comparison of the prognostic significance of tumor diameter, length, width, thickness, area, volume, and clinicopathological features of oral tongue carcinoma. Am J Surg 180(2):139–143CrossRefPubMedGoogle Scholar
  97. Yuen AP, Ng RW, Lam PK, Ho A (2008) Preoperative measurement of tumor thickness of oral tongue carcinoma with intraoral ultrasonography. Head Neck 30(2):230–234CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of OtolaryngologyUniversity of Pittsburgh Medical CenterPittsburghUSA

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