Muhammad Ance Anwer, Shakil Aqil, Maisam Abbas Onali, Uzma Tanveer.
Oral Carcinoma : Role of Neck Dissection in No Nodes.
Pak J Otolaryngol Jan ;30(2):37-40.

OBJECTIVE: To study the role of extent of an elective neck dissection in patients presenting with oral squamous cell carcinoma and clinically negative neck nodes. RATIONALE: With the increasing incidence of oral squamous cell carcinoma in our part of the world, different surgical modalitsis are being practiced to address one of its major poor prognostic factors – the cervical lymph node metastasis. The purpose of this study is to find out the extent to which the elective neck dissection can be outlined in clinically negative neck patients. An extent which provides an adequate access to the involved lymph nodes, as well as which results in minimal post-operative morbidity. STUDY DESIGN: Retrospective study. PLACE AND DURATION OF STUDY: Department of Otolaryngology – Head and Neck Surgery, Liaquat National Hospital and Medical College, Karachi, from January 1995 to December 2013. METHODOLOGY: Medical records reviewed of patients who underwent excision of primary tumor of the oral cavity primarily tongue, cheek and retromolar trigone combined with an ipsilateral neck dissection. All patients who had primary squamous cell carcinoma greater than 2 cm with clinically negative neck nodes were included in the study. Post-operative histopathology was reviewed comparing the outcome of disease metastasis to various neck levels. ETHICAL CONSIDERATION: All the records were reviewed with the permission and under the supervision of the head of the department. RESULTS: Out of 95 patients in the study, 47 were T2 tumors, 27 were T3 tumors, and 21 were T4 tumors. For T2 tumors, 19 patients (40.42%) had neck metastasis; for T3 tumors, 14 patients (51.85%); and for T4 tumors, 18 patients (85.71%) had neck metastasis on final histopathology. All histological positive nodes in the neck were from level 1 to 3 with only tongue primary showing some skip metastasis to level 4 and overall there was zero metastasis to level 5. CONCLUSION: All patients presenting with T2 or above oral carcinoma with a clinically negative neck should undergo a selective neck dissection which can be extended to include level 4 for advance stage primary tumors of the tongue. Modified radical neck dissection is not indicated due to negligible rates of level 5 involvement.

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