Preserving Level IIb Lymph Nodes in Elective Supraomohyoid Neck Dissection for Oral Cavity Squamous Cell Carcinoma

Abstract

To determine whether level IIb lymph nodes can be saved in elective supraomohyoid neck dissection (SOHND) as a treatment for patients with squamous cell carcinoma of the oral cavity. Design: Prospective analysis of a case series. Setting: University hospital. Patients and Interventions: From 1997 to 2001, 74 patients with squamous cell carcinoma of the oral cavity and with no palpable lymph nodes at the neck who underwent an elective SOHND were prospectively studied. Main Outcome Measures: The incidence of pathological metastasis to level IIb lymph nodes and the regional recurrence within this area after elective SOHND was performed were evaluated. Results: Of the 74 patients, 24 (32%) had lymph nodes positive for microscopic metastatic squamous cell carcinoma. Four (5%) of the 74 patients had involvement of level IIb lymph nodes. There was no instance of isolated metastasis to level IIb lymph nodes without involvement of other nodes in the SOHND specimens. There were 6 cases of the ipsilateral neck recurrences, and of these, 2 patients (3% of all patients) developed recurrences in the level II lymph nodes. Conclusions: Level IIb lymph node metastasis was rare in this study, and nodal recurrence in this area after SOHND in squamous cell carcinoma of the oral cavity was infrequent. Therefore, this region may be preserved in elective SOHND in patients with squamous cell carcinoma of the oral cavity.

Level IIb Neck Dissection in Oral Cavity Cancers- When Should One Address it..?

“…There was no instance of isolated or contralateral metastases at level IIb. This was in accordance with results of other authors [15,16,17] . Palleri et al in their prospective study of 50 patients found a positivity at level IIb in 3.9 % oral cavity cancers with contralateral (0.9 %) and isolated (0.3 %) metastases being extremely rare.…”

“…Lim et al studied 74 patients with node negative necks and found 5.4 % positivity at level IIb with primaries always being the tongue cancer and no isolated metastases reported [16]. Our study too showed increased propensity for tongue tumours to metastasize to level IIb.…”

Metastases to level IIb in squamous cell carcinoma of the oral cavity: A systematic review and meta‐analysis

“…[10][11][12][13][14][15][16][17][18][19][20][21][22] Four of these articles were subsequently excluded after obtaining additional study information from the respective authors. [19][20][21][22] Figure 1 lists the specific reasons for exclusion at this stage.…”

“…Among the 15 patients with detailed nodal metastases data, all had concomitant level IIa disease in addition to IIb disease. Thus, 85% of those with level IIb metastases (17/20) demonstrated additional 10 Each study had its own unique inclusion and exclusion criteria, some including only clinically negative necks and others including all patients regardless of nodal disease status. Many studies set out to assess the rate of level IIb nodal metastases in patients with head and neck cancer, comprising numerous sites of which the oral cavity is 1 subsite.…”

Molecular Assessment of Neck Dissections Supports Preserving Level IIB Lymph Nodes in Selective Neck Dissection for Laryngeal Squamous Cell Carcinoma with a Clinically Negative Neck

“…However, there may be various postoperative morbidities after an SND, the most common of which is postoperative spinal accessory nerve dysfunction and related shoulder disability. Nerve dysfunction is usually attributed to traction and elevation of the nerve during dissection of level IIB, in addition to ischemia and neuropraxia of the nerve caused by the ligation of the occipital branch of the external carotid artery [6,22] . Kraus et al [6] reported that 50% of patients who underwent spinal accessory nervesparing procedures experienced a shoulder drop and 30% of patients who underwent a minimal spinal accessory nerve dissection had pain and shoulder dysfunction.…”