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PubMed2002

Results of salvage treatment of the neck in patients with oral cancer.

BACKGROUND: About 50% of the patients with neck recurrences after the treatment of oral squamous cell carcinoma are not considered candidates for further treatment, and reported survival is generally poor. OBJECTIVE: To evaluate the prognostic importance of neck recurrences and results of salvage treatment in patients with oral carcinoma. PATIENTS: Five hundred thirteen patients with squamous cell carcinoma of the oral cavity underwent surgical treatment, with follow-up from less than 2 to 119 months (mean, 16.9 months). SETTING: Referral center, private or institutional practice, and ambulatory and hospital care center. INTERVENTION: Four hundred forty-eight patients underwent neck dissection, and 65, resection of the primary tumor only. Postoperative radiotherapy was used for 228. MAIN OUTCOME MEASURES: Rates of neck recurrences and survival after salvage treatment. RESULTS: Eighty-two patients (16.0%) had neck recurrences, including ipsilateral in 44, contralateral in 31, and bilateral in 7. Most neck recurrences (77 [94%]) were diagnosed within 2 years. Salvage treatment was attempted in 51 patients (62%). Of the patients with a previously untreated side of the neck, 27 underwent radical neck dissections (11 ipsilateral and 16 contralateral) and only 5 remained with no evidence of disease. The significant factors associated with survival after neck recurrence were type of previous neck dissection (P<.001), previous postoperative radiotherapy (P =.003), and interval free of neck recurrence (P<.001). CONCLUSIONS: Patients undergoing previous neck dissection and with recurrences diagnosed after 6 months are not usually candidates for curative salvage treatment and are at a high risk for death. Only 5 of 46 patients with recurrences in a previously untreated side of the neck survived after salvage treatment. Patients with neck recurrences have a poor prognosis, despite salvage treatment.

Adult↗
PubMed1992

The superior trapezius myocutaneous flap in head and neck reconstruction.

The superior trapezius myocutaneous flap, based on the paraspinous perforating branches of the intercostal vessels, is generally not a first-line choice for reconstruction of head and neck defects. However, after wound breakdown following radical neck dissection and radiation therapy, the superior trapezius flap is extremely reliable for coverage of exposed major neck vessels. The flap was used in 30 patients undergoing lateral neck reconstruction. All 30 patients had undergone prior neck dissection and all but two had undergone prior radiation therapy. There were no flap failures. The superior trapezius flap is unique among other regional myocutaneous flaps presently in use in that it has a superiorly based pedicle, which reduces the problem of gravitational pull on the suture lines of severely unfavorable recipient beds. Another advantage of using the denervated muscle of this flap is that it imposes no additional functional loss. The deficiencies of this flap are primarily related to its limited arc of rotation, thereby precluding its use when resurfacing defects that extend beyond the midline of the neck. The reliability of the superior trapezius flap after neck dissection can be explained by the angiosome concept. Based on that concept, previous ligation of the transverse cervical vessels during a neck dissection serves to simultaneously stage this flap, thereby improving its reliability and potential surface area available.

Adult↗
PubMed1992

Vertebral artery dissection from neck flexion during paroxysmal coughing.

Vertebral artery dissection has a characteristic presentation that should be considered when symptoms are preceded by any trauma that causes neck movement. We present the case of a man with vertebral artery dissection following severe coughing that presented as a postero-inferior cerebellar artery territory stroke. The patient was anti-coagulated, and his neurologic deficits were partially resolved. The mechanism and presentation of vertebral artery dissection are discussed with an emphasis on early detection.

Adult↗
PubMed2005

[Re-operation for thyroid carcinoma].

OBJECTIVE: To evaluate the results of re-operation of thyroidectomy for patients of thyroid carcinoma. METHODS: 268 patients of thyroid carcinoma received completion thyroidectomy were retrospectively reviewed from 1984 to 2000. There were 59 males and 209 female cases. 256 cases had received nodule enucleating or partial thyroidectomy in other hospitals and 12 cases had unilateral subtotal thyroidectomy in this hospital. The types of reoperation were: Total thyroidectomy for bilateral thyroid carcinoma (6 cases); expand isthmectomy for isthmus carcinoma (1 case). Lobectomy plus isthmectomy for unilateral disease (261) Simultaneous neck dissections were performed in 196 cases. Among them, 94 cases had classical neck dissection, 102 cases had modified neck dissection. RESULTS: Pathological results confirmed that there were 78 cases with residual thyroid carcinoma. The rate of residual carcinoma was 29. 1% (78/268). There were 95 cases with lymphnode metastasis. The rate of lymphnode metastasis was 48.5% (95/196). The rate of recurrent laryngeal nerve injury was 1.1% (3/268). The 5-year and 10-year survival rates of patients were 94. 0% (251/267) and 85. 2% (127/149) respectively. CONCLUSIONS: The residual carcinoma of completing thyroidectomy was high. Therefore re-operations of thyroid in selected cases were necessary.

Adolescent↗
PubMedDate not supplied

[Treatment of metastatic neck squamous cell carcinomas with unknown primary].

INTRODUCTION: Treatment of metastatic neck squamous cell carcinomas of unknown primary is one of the most serious problems in head and neck oncology. MATERIAL AND METHODS: Fifty-one patients were analyzed during the period 1977-1997. All patients underwent clinical examination of head and neck, hematological and laboratory tests, X-ray of paranasal sinuses, esophagus and lungs, scintigraphy of the thyroid gland, epipharyngoscopy, esophagoscopy and laryngotracheobronchoscopy, biopsy of suspected changes and blind biopsy of suspected regions (epipharynx, tongue base, piriform sinus), ipsilateral tonsillectomy (17 patients), examination of gastrointestinal tract, kidneys, prostate, testicles, and breasts and ovaries, respectively. RESULTS: Almost half of metastases developed in the II level of the neck (49.01%; 25/51). Most metastases were 3-6 cm in diameter (N2)--60.76% (31/51). Forty patients were surgically treated by various neck dissection methods and postoperative radiotherapy (60 Gy). Palliative radiotherapy was applied in patients with inoperable metastases. Eighteen patients had a five-year disease free survival (35.29%). DISCUSSION: Metastases localized in the II and III levels of the neck and in the upper two-thirds of the V level, should be primarily treated by neck dissection. Lymph nodes up to 3 cm in diameter (N1) are operated by a modified radical neck dissection. Lymph nodes over 3 cm (N2) and 6 cm in diameter (N3) are operated by radical or extended radical neck dissection. CONCLUSION: Primary surgery plus postoperative radiotherapy provide satisfactory results in therapy of metastatic squamous cell carcinomas of the neck with unknown primary.

Carcinoma, Squamous Cell↗
PubMed1994

Accuracy of clinical examination versus computed tomography in detecting occult lymph node involvement in patients with oral epidermoid carcinoma.

PURPOSE: To determine the accuracy of clinical examination versus computed tomography (CT) scanning in detecting positive cervical lymph nodes (N) in patients with epidermoid carcinomas of the oral cavity, 27 patients with epidermoid carcinomas were reviewed. PATIENTS AND METHODS: The patients underwent 40 neck dissections, 20 with N- and 20 with N+ necks histologically. All patients were examined by the same clinician, and all CT scans were read by the same radiologist. Patients with clinical and CT N- necks underwent neck dissection only if the neck had to be entered to resect the primary tumor or if the primary tumor was T3 or T4 with a high probability of microscopic metastasis. RESULTS: Of the 20 necks that were histologically N-, 16 (80%) were clinically diagnosed as N- and 4 (20%) N+ versus 18 (90%) N- and 2 (10%) N+ diagnosed by CT scan. Of the 20 histologically N+ necks, 12 (60%) were clinically diagnosed as N+ and 8 (40%) N- versus 11 (55%) N+ and 9 (45%) N- diagnosed by CT scan. All lymph nodes diagnosed as N- by both clinical examination and CT scan were less than 1 cm in diameter. Overall, clinical examination of the neck was correct in 28 patients (70%) and the CT scan was correct in 29 patients (73%). Both clinical examination and CT scan were more accurate in diagnosis of N- necks. In 31 necks (78%), the CT and clinical examination were in agreement. Of these, 10 of 10 (100%) were correctly positive. Of the 21 in which both were negative, 14 were histologically N-, and 14 (67%) were correct. Overall, in those cases in which both CT and clinical examination were in agreement, the diagnosis was correct in 24 of 31 (77%). CONCLUSION: These results suggest that there is no significant difference in the accuracy of clinical examination versus CT scanning in detecting both positive and negative cervical nodes. When both CT and clinical examination agree, positive cervical nodes are almost always correctly diagnosed. However, one third of the negative cervical nodes were incorrectly diagnosed. Improved methods for detecting occult disease are still needed.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Management of cervical lymph nodes in squamous carcinomas of the head and neck.

Due to the overwhelming prognostic significance of regional metastases, proper management of cervical lymph nodes in cases of squamous cell carcinoma of the head and neck is essential for an optimal outcome. Better understanding of the predictability of incidence and patterns of metastases of these tumors in recent years has led us away from the radical neck dissection as the only surgical therapeutic or staging procedure done on the neck. Recent studies suggest that selective removal of lymph node groups at risk in clinically negative necks, or modified neck dissections that save important structures, like the jugular vein, XI nerve, and sternocleidomastoid muscle, in clinically positive necks, are appropriate in many patients. Careful selection of the type of neck dissection and judicious use of postoperative radiation therapy can optimize cure rates as well as functional and cosmetic results.

Carcinoma, Squamous Cell↗
PubMed2004

[Diagnosis of lateral cervical lymph node metastasis of papillary carcinoma of the thyroid by ultrasonography].

No consensus for papillary carcinoma of the thyroid exists on the preoperative diagnosis of lateral cervical lymph node metastasis, indications, or range of neck dissection, so we studied the usefulness and limits of ultrasonography and sufficient dissection by comparing preoperative ultrasonographic and postoperative histopathological diagnosis. Subjects were 45 patients (51 affected sides) with lateral cervical lymph node metastasis of papillary carcinoma of the thyroid who underwent modified neck dissection between July 1997 and July 2003. Preoperative ultrasonographic and postoperative histopathological diagnosis were compared. Specimens excised by neck dissection contained 1,325 lymph nodes. Of these, 198 (15%) detected by preoperative ultrasonography were selected for investigation of diagnostic criteria for metastasis-positive lymph nodes. The best criterion for the diagnosis of metastasis-positive lymph node was 0.5 or greater [minor axis/major axis] with 6 mm or greater minor axis at levels III, IV, or V (7 mm or greater at level II), and sensitivity, specificity, and accuracy were 78%, 100%, and 84% respectively. The lateral cervical lymph node metastasis rate obtained by this diagnostic criterion was 41%. Regional histopathological metastasis positivity was investigated in the lateral cervical region, and high positivity rates were obtained: 57% at level II, 71% at level III, and 84% at level IV. Considering these findings and the preoperative ultrasonographic diagnosis rate of 41%, sufficient dissection at levels II-IV may be necessary for patients in whom lateral cervical metastasis is observed before surgery. The metastasis rate was 10% at level V, but dissection should always be done in lateral cervical metastasis-positive patients because: 1) No trend was observed in age, gender, the number of metastatic lymph nodes, or regional metastasis rate; 2) no anatomical boundary is present between levels II, III, IV and level V; 3) no functional disorder due to preservation of the accessory nerve occurred; 4) the prognosis of patients with advancement to the accessory nerve was poor; and 5) improvement of the prognosis of papillary carcinoma of the thyroid by modified radical neck dissection has been reported.

Adolescent↗
PubMed1990

Cervical lymph nodes from an unknown primary tumor in 190 patients.

Over 10 years, 475 patients with isolated lateral neck masses were evaluated: 190 with lymph nodes from an unknown primary tumor (LNUP), 188 with neck lymphomas, 78 with benign tumors, 10 with sarcomas, and 9 with chemodectomas. This study focused on the patients with LNUP. Only 86 patients were treated with surgery (plus radiotherapy). Other patients were treated with radiotherapy (84) or chemotherapy (13) or had no treatment (7). For the overall population, failures in the neck occurred in 51% of the patients and distant metastases in 27%, while primary tumors appeared in 16%. Survival rates at 3, 5, and 10 years were 27%, 19%, and 7%, respectively, for the overall population and 45%, 35%, and 19%, respectively, for the surgical group. The diagnosis and therapeutic approach had a direct effect on neck control; failure in the neck occurred in 7 of 47 patients (15%) when fine needle aspiration and radical neck dissection with radiotherapy were performed, in 5 of 12 patients (42%) when fine needle aspiration and modified neck dissection with radiotherapy were used, in 5 of 12 patients (42%) when adenectomy diagnosis and radiotherapy treatment were performed, and in 6 of 11 patients (54%) when diagnosis by incisional biopsy was performed prior to admission, despite subsequent radical neck dissection and radiotherapy treatment. In our opinion, panendoscopy and fine needle aspiration should be the first-line diagnostic approach. When cytologic diagnosis proves impossible, the second-line approach must consist of cervical exploration with frozen section examination and excisional biopsy, followed by immediate appropriate treatment. In cases of LNUP, radical neck dissection seems to be preferable.

Female↗
PubMed2005

Reliability of sentinel lymph node biopsy with squamous cell carcinoma of the oral cavity.

OBJECTIVES: Although sentinel lymph node biopsy (SLNB) may reduce surgery-related complications related to unnecessary lymph node dissection and is now widely used for many patients with cutaneous melanoma and breast cancer, its use for oral cancer patients remains controversial. One of the main reasons for the reluctance to initiate SLNB for oral cancer is that the frequency of skip metastasis has not been clarified. The objectives of this study are to examine the frequency of skip metastasis and to evaluate SLNB for oral cancer. STUDY DESIGN: To shed light on these concerns, we first conducted a retrospective study of 296 patients with squamous cell carcinoma of the oral cavity who underwent neck dissection. Next, the accuracy of lymph node biopsy with and without detecting sentinel lymph node was examined. RESULTS: Ten patients showed skip neck metastasis in the level III-V region without level I-II involvement. Of these patients, 7 underwent neck dissection when their initially N0 neck progressed to N+, 2 underwent neck dissection when local recurrence occurred, and only 1 underwent surgery as an initial therapy. Most patients who underwent neck dissection as the initial therapy showed skip metastasis. Intraoperative lymph node biopsy without any attempt to detect sentinel lymph nodes by means of blue dye or lymphoscintigraphy was performed on 68 patients with oral cancer. Sixty-one (90%) were diagnosed correctly, whereas 7 diagnosed as N- actually had neck metastasis. SLNB with blue dye was performed on 21 patients. In 17 of them, sentinel lymph node was easily detected, resulting in a correct diagnosis for 16 patients (94%), while 1 with a false negative result actually had micrometastasis. CONCLUSION: These findings seem to suggest that SLNB is useful and can be applied to patients with oral cancer who undergo surgery as the initial therapy.

Adult↗
PubMed1983

[Results of ionizing radiation treatment of 2274 epidermoid epitheliomas of the lips].

In preparation for the 18th meeting of the European Curietherapy Group, devoted to cancer of the lip, 2 363 cases of lip cancer from 23 European Hospitals were retrospectively analysed. After presentation of these results, several free communications, and a large interdisciplinary panel discussion, a consensus was reached for the management of the primary tumor and the regional lymph nodes. Interstitial implant with iridium 192 wires results in a local recurrence rate which does not excede 3,4%. This method may be considered the treatment of choice for T1 and T2 tumors and many T3 tumors. On the other hand surgery should be used for in situ tumors and very large deeply infiltrating tumors. As the 2% failure rate after routine prophylactic neck dissection does not significantly differ from the 3% failure rate when patients undergo neck dissection only if clinically positive neck nodes develop, patients with T1, T2 tumors and no palpable neck nodes, who can be expected to submit to regular follow-up examination, may be managed conservatively. Patients with clinically positive neck nodes should undergo a neck dissection followed by radiationtherapy.

Carcinoma, Squamous Cell↗
PubMed1997

Utilization of intraoperative electroneurography to understand the innervation of the trapezius muscle.

The radical neck dissection is an operation for the management of lymph node metastases from primary sites involving the oral cavity, larynx, and other areas of the head and neck. In this procedure, the spinal accessory nerve is removed along with other structures. In modified neck dissection the spinal accessory nerve is preserved. Patients undergoing the modified neck dissection have had variable functional outcomes from little or no pain or disability, to significant muscle dysfunction. Our group hypothesized that patients with good functional outcomes following modified neck dissection may have had motor contributions from C2, C3, or C4 branches, while those with less favorable outcomes did not. To demonstrate the presence of motor input and its significance both from the spinal accessory nerve and the branches of the cervical plexus, we utilized intraoperative electroneurography. We find that although there is motor contribution from C2, C3, and C4 to the trapezius muscle, it was not consistent or significant.

Cervical Plexus↗
PubMed1995

[Papillary microcancer of the thyroid].

The aim of this study was to determine the outcome of patients operated for microscopic papillary cancer of the thyroid. Between 1962 to 1991, among 1103 patients operated for papillary thyroid carcinoma, 115 (11.5%) had a cancer with a diameter of 10 mm or less, no clinically detectable. 48 patients were diagnosed incidentally at the time of operation for other thyroid diseases, and 67 patients presented cervical lymph node metastases as the first sign. For patients diagnosed for other thyroid diseases, unilateral lobectomy with local neck dissection was performed in 35 cases, and in patients with cervical lymph node metastases unilateral lobectomy with locoregional neck dissection was performed in 56 cases. Mean overall follow-up was 12 years, and median follow-up time of 105 surviving patients was 10 years. 10-year survival rates were 100% in the patients diagnosed for other thyroid diseases, and 87% in patients with cervical lymph node metastases (P < 0.05). Out of 48 patients with no cervical lymph nodes, 44 were alive, and 4 died without recurrence or metastases. Out of the 67 patients with cervical lymph nodes, 5 died of the carcinoma. These results suggest that for patients diagnosed for other thyroid diseases, unilateral lobectomy with local neck dissection is sufficient, and for patients with cervical lymph node metastases unilateral lobectomy and locoregional neck dissection is necessary.

Adolescent↗
PubMed1981

Experience of the Curie Institute in treatment of cancer of the mobile tongue: II. Management of the neck nodes.

Treatment of neck nodes of 602 patients with cancer of the mobile tongue was mainly surgical. Three-hundred-eighty-three (64%) were clinically N0, and 244 had elective neck dissection. Thirty-four percent (84/244) had occult metastasis. Thirteen percent (33/244) had major nodal involvement (greater than 3N + and/or extracapsular spread) and received postoperative radiotherapy. Twenty-one percent (7/33) recurred in the neck. Thirty-six percent (12/33) were alive, NED, at five years. Sixty-six percent (160/244) were N-, and 21% (51/244) had minimal nodal disease (less than or equal to 3N+) and did not receive postoperative radiotherapy; recurrence in neck was similar (7% and 14%) as well as the five-year survival (54% and 51%). Twenty-one patients had preoperative radiotherapy to the neck. Only one (5%) experienced recurrence of disease. Fifty had radiotherapy only. Seven (14%) failed in the neck. There were 219 patients who had clinically positive nodes and 120 who had radical neck dissection. One-hundred-one of these patients did not receive preoperative radiotherapy. Sixty-three percent (64/101) had nodal metastasis, and 27% (27/101) had major nodal involvement. In this group of patients, for the same degree of nodal involvement, postoperative recurrences in neck and the survival were similar to that of patients with clinically N0 neck, except for those with major nodal involvement. This latter group had a dismal five-year survival (12%). Nineteen had preoperative radiotherapy, and three (16%) had recurrence of disease in the neck. At present, patients with clinically N0 neck and small primary (less than or equal to 3 cm), who are therefore at low risk of failure at primary, receive brachytherapy and conservative neck dissection. Postoperative radiotherapy is given if major nodal metastasis exists. Those with larger primary (high risk of failure) receive neck irradiation only, since many will require combined resection at a later date. All patients with clinically positive nodes are treated preoperatively with 5500 rads before neck dissection.

Brachytherapy↗
PubMed2002

A study comparing different approaches in managing neck nodes in early carcinoma of the tongue.

OBJECTIVE: To evaluate elective neck treatment in patients with early stage (T1-2 negative neck node [N0]) squamous cell carcinoma of the oral tongue. METHODS: The medical records of all patients with early stage (T1-2 N0) of oral tongue cancer at the King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia, between January 1980 and December 1997, were identified and retrospectively reviewed. RESULTS: Our cohort consisted of 93 patients: 45 males and 48 females, with a median age of 60 years. All patients received treatment with curative intent. Partial glossectomy was carried out, except for 8 patients who underwent tongue brachytherapy. The neck was observed in 29 patients, 36 were treated by modified neck dissection, and 28 by elective neck irradiation. With a median follow-up of 62 months, 29 patients had documented neck node recurrence. Ninety six percent (28/29) of recurrences occurred within 22 months from treatment completion. The 5 year actuarial event free survival with regard to nodal relapse in observed was 59%, dissected was 79% and irradiated neck was 63%. Our results showed a trend toward better neck node control in patients managed by elective neck dissection compared to those observed (p=0.07) or receiving elective neck irradiation (p=0.18). Tumor thickness of more than 10 mm was associated with increased risk of nodal relapse (p=0.0004). Neck node recurrence has a poor prognosis with a 5 year disease specific survival of 16%. CONCLUSION: A trend for higher neck control was observed after neck dissection in patients with T1-2 N0 squamous cell carcinoma of the oral tongue. Elective neck dissection should be considered particularly for patients with tumor thickness of more than 10 mm.

Aged↗
PubMed2001

[Lymph node metastasis of cutaneous epidermoid carcinomas of the head and neck: prognostic factors and therapeutic strategies. Apropos of a series of 13 cases].

UNLABELLED: Squamous cell skin carcinoma has a relatively low rate of metastasis (0.5 to 16%), but the prognosis of these metastases is poor (22% of survival at 5 years). PATIENTS AND METHODS: from a series of 243 patients, we studied 13 patients who were found initially to have metastases or who developed metastases later. Fifty-four percent (54%) of the patients presented initially with regional lymph node and parotid involvement in 54%. RESULTS: All patients underwent surgery with removal of the skin cancer and a neck dissection. Radiotherapy was performed later in 92% of the cases. The 2 years survival rate was 62% and mean survival by Kaplan Meier curve was 47 months. DISCUSSION: Poor criteria of these cutaneous tumors are defined: tumor size, histologic differentiation, perineural spread. Patients with severe criteria must have a neck dissection to control the first lymph node. Along the anatomic area of the cutaneous tumor, a parotidectomy, a submaxillary control or a neck dissection will be performed. Its involvement will be followed by a neck dissection. A comparative study of the literature is made. Poor prognostic criteria of these cutaneous tumors are defined, in addition to the initial management of the cervical and parotid lymph nodes.

Aged↗
PubMedDate not supplied

Lymphoepithelial carcinoma of salivary glands.

BACKGROUND: Malignant lymphoepithelial lesions (MLEL) or lymphoepithelial carcinoma or undifferentiated carcinoma with lymphoid stroma, is a rare but unique malignancy of the major salivary glands. There is an exceptionally high incidence in Eskimos and native Greenlanders, but it has never been reported in the Arab population. We report the first case from Saudi Arabia in the native Arabs. These are unencapsulated tumors with a strong tendency to metastasize to the regional lymph nodes. METHODS: We reviewed English and Arabic literature and found the total number of reported cases of MLEL to be 103 with predominant involvement of the parotid gland. Parotidectomy followed by neck dissection and radiotherapy was performed, with a survey of the nasopharynx and EB virus titer. RESULTS: The patient underwent radical neck dissection followed by radiation after developing the neck metastasize. Three years to date he remains in remission with no distant or regional metastases. CONCLUSION: Malignant lymphoepithelial lesions of the salivary gland are unencapsulated tumors with poorly differentiated epithelial cells scattered throughout fibrolymphocytic stroma. They have a strong tendency to metastasize to the regional lymph nodes with predominant involvement of the parotid gland. They are commonly associated with Epstein-Barr virus infection. The majority of them are radiosensitive. Combination therapy with surgery and radiation is desirable to control the disease. We recommend complete surgical excision with neck dissection followed by postoperative radiotherapy to the local site as well as to the neck as treatment of choice.

Arabs↗
PubMed2003

Distribution of metastatic lymph nodes in oropharyngeal carcinoma and its implications for the elective treatment of the neck.

OBJECTIVES: To analyze the distribution of lymph node metastases in patients with oropharyngeal squamous cell carcinoma and improve the rationale for elective treatment of the neck. DESIGN AND SETTING: Retrospective cohort study of patients evaluated from 1990 to 1998 in a tertiary cancer care center. PATIENTS: The 81 consecutive patients who were identified from the hospital database. Patients were eligible for the study if they had a previously untreated squamous cell carcinoma of the oropharynx and histopathologically diagnosed lymph node metastases without a second primary tumor treated by an en bloc resection. MAIN OUTCOME MEASURES: We analyzed the anatomic distribution of lymph node metastases. RESULTS: The clinical neck cancer stages were N0 in 22 cases, N1 in 22, N2a in 8, N2b in 14, N2c in 4, and N3 in 11. The most common sites for the metastases detected clinically as well as histopathologically were at levels II and III. Histologically, level I alone was involved in 5 cases and level IV alone was involved in none. Sixteen patients with N0 neck cancer stage underwent a radical neck dissection. There were 2 cases of metastases at level I and no level IV involvement. CONCLUSIONS: Pathological lymph nodes in oropharyngeal squamous cell carcinoma are more frequent at level I than at level IV. This finding suggests that elective neck dissection for patients with oropharyngeal carcinoma should be a supraomohyoid neck dissection (levels I, II, and III) rather than a lateral neck dissection (levels II, III, and IV).

Adult↗