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Management of the Neck

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Oral Cancer

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Abstract

Regional nodal status is one of the most significant prognostic factors in patients with oral squamous cell carcinoma; therefore, diagnosis and treatment of cervical nodal disease is one of the most highly debated topics among head and neck surgeons. Imaging modalities currently available in clinical practice include ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography. However, none of these methods can independently confirm occult metastasis. A patient’s risk of regional metastasis is determined through clinicopathological evaluation of the primary tumor. Elective management of the neck is warranted when the risk of occult metastasis is >20 %. In these situations, the modality of elective treatment is influenced by that selected to treat the primary tumor. When surgery is indicated, selective neck dissection (SND [I–III)] is generally required; however, SND (I–IV) is recommended for patients with tongue squamous cell carcinoma. Modified radical neck dissection is the gold standard for the N-positive neck; however, SND is applicable in selected patients. For patients with multiple node metastases or extracapsular spread, postoperative radiotherapy or chemoradiotherapy is recommended as soon as possible after surgery.

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References

  1. Schuller DE, McGuirt WF, McCabe BF et al (1980) The prognostic significance of metastatic cervical lymph nodes. Laryngoscope 90: 557–570

    CAS  PubMed  Google Scholar 

  2. O’Brien CJ, Smith JW, Soong SJ et al (1986) Neck dissection with and without radiotherapy: prognostic factors, patterns of recurrence and survival. Am J Surg 152:456–463

    Article  PubMed  Google Scholar 

  3. Ferito A, Robbins KT, Medina JE et al (2002) Is it time to eliminate confusion regarding cervical lymph node levels according to the scheme originated at the Memorial Sloan-Kettering Cancer Center? Acta Otolaryngol 122:805–807

    Article  Google Scholar 

  4. Robbins KT, Clayman G, Levine PA et al (2002) Neck dissection classification update. Revisions proposed by the American Head and neck society and the American academy of otolaryngology-head and Neck surgery. Arch Otolaryngol Head Neck Surg 128: 751–758

    Article  PubMed  Google Scholar 

  5. Robbins KT, Shaha AR, Medina JE et al (2008) Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg 134:536–538

    Article  PubMed  Google Scholar 

  6. Sheahan P, Colreavy M, Toner M et al (2004) Facial node involvement in head and neck cancer. Head Neck 26:531–536

    Article  PubMed  Google Scholar 

  7. Harada H, Omura K (2009) Metastasis of oral cancer to the parotid node. Eur J Surg Oncol 35:890–894

    Article  CAS  PubMed  Google Scholar 

  8. Umeda M, Shigeta T, Takahashi H et al (2004) Metastasis to the lateral retropharyngeal lymph node from squamous cell carcinoma of the oral cavity: report of three cases. Int J Oral Maxillofac Surg 38:1004–1008

    Article  Google Scholar 

  9. Shah JP (1990) Patterns of cervical lymph node metastasis from squamous cell carcinomas of the upper aerodigestive tract. Am J Surg 160:405–409

    Article  CAS  PubMed  Google Scholar 

  10. Byers RM, Weber RS, Andrews T et al (1997) Frequency and therapeutic implications of ‘skip metastases’ in the neck from squamous cell carcinoma of the oral tongue. Head Neck 19:14–19

    Article  CAS  PubMed  Google Scholar 

  11. Rapoport A, Ortellado DK, Dedivitis RA (2009) Rationale for selective neck dissection in N + oral cancer. Int Surg 94:339–343

    PubMed  Google Scholar 

  12. Sako K, Pradier RN, Marchetta FC et al (1964) Fallibility of palpation in diagnosis of metastasis to cervical nodes. Surg Gynecol Obstet 118:989–990

    CAS  PubMed  Google Scholar 

  13. Ali S, Tiwari RM, Snow GB (1985) False positive and false negative neck nodes. Head Neck 8:78–82

    Article  CAS  Google Scholar 

  14. Baatenburg De Jong RJ, Rongen RJ, Lameris JS et al (1989) Metastatic neck disease. Palpation vs ultrasound examination. Arch Otalaryngol Head Neck Surg 115:689–690

    Article  CAS  Google Scholar 

  15. van den Breckel MW, Castelijns JA, Stel HV et al (1993) Modern imaging techniques and ultrasound-guided aspiration cytology for assessment of neck node metastases: a prospective comparative study. Eur Arch Otorhinolaryngol 250:11–17

    Article  Google Scholar 

  16. Stern WB, Silver CE, Zeifer BA et al (1990) Computed tomography of the clinically negative neck. Head Neck 12:109–113

    Article  CAS  PubMed  Google Scholar 

  17. Friedman M, Shelton VK, Mafee M et al (1984) Metastatic neck disease. Evaluation by computed tomography. Arch Otolaryngol 110:443–447

    Article  CAS  PubMed  Google Scholar 

  18. Yucel T, Saatci I, Sennaroglu L et al (1997) MR imaging in squamous cell carcinoma of the head and neck with no palpable lymph nodes. Acta Radiol 38:810–814

    Article  CAS  PubMed  Google Scholar 

  19. Curtin HD, Ishwaran H, Mancuso AA et al (1998) Comparison of CT and MR imaging in staging of neck metastases. Radiology 207:123–130

    Article  CAS  PubMed  Google Scholar 

  20. Curtin HD, Weissman JL (1996) Radiologic evaluation of head and neck cancer. In: Myers EN, Suen JY (eds) Cancer of the Head and Neck, 3rd edn. WB Saunders, Philadelphia

    Google Scholar 

  21. Ng SH, Yen TC, Chang JT et al (2006) Prospective study of [18 F]fluolodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck. J Clin Oncol 24:4371–4376

    Article  PubMed  Google Scholar 

  22. Nahmias C, Carlson ER, Duncan LD et al (2007) Positron emission tomography/computerized tomography (PET/CT) scanning for preoperative staging of patients with oral/head and neck cancer. J Oral Maxillofac Surg 65:2524–2535

    Article  PubMed  Google Scholar 

  23. de Bondt RB, Nelemans PJ, Hofman PA et al (2007) Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging. Eur J Radiol 64:266–272

    Article  PubMed  Google Scholar 

  24. Peters BR, Schnadig VJ, Quinn FB Jr et al (1989) Intraobserver variability in the interpretation of fine-needle aspiration biopsy of head and neck masses. Arch Otolaryngol Head Neck Surg 115: 1438–1442

    Article  CAS  PubMed  Google Scholar 

  25. McGuirt WF, McCabe BF (1978) Significance of node biopsy before definitive treatment of cervical metastatic carcinoma. Laryngoscope 88:594–597

    CAS  PubMed  Google Scholar 

  26. Robbins KT, Cole R, Marvel J et al (1991) The violated neck: cervical node biopsy prior to definitive treatment. Otolarygol Head Neck Surg 117:60–61

    Article  Google Scholar 

  27. Ellis ER, Mendenhall WM, Rao PV et al (1991) Incisional or excisional neck-node biopsy before definitive radiotherapy, alone or followed by neck dissection. Head Neck 13:177–183

    Article  CAS  PubMed  Google Scholar 

  28. Terada A, Hasegawa Y, Yatabe Y et al (2011) Follow-up after intraoperative sentinel node biopsy of N0 neck oral cancer patients. Eur Arch Otorhinolaryngol 268:429–435

    Article  PubMed  Google Scholar 

  29. Melkane AE, Mamelle G, Wycisk G et al (2012) Sentinel node biopsy in early oral squamous cell carcinomas: a 10-year experience. Laryngoscope 122:1782–1788

    Article  PubMed  Google Scholar 

  30. Broglie MA, Haerle SK, Huber GF et al (2013) Occult metastases detected by sentinel node biopsy in patients with early oral and oropharyngeal squamous cell carcinomas: impact on survival. Head Neck 35:660–666

    Article  PubMed  Google Scholar 

  31. Snow GB, Annyas AA, van Slooten EA et al (1982) Prognostic factors of neck node metastasis. Clin Otolaryngol 7:185–192

    Article  CAS  PubMed  Google Scholar 

  32. Johnson JT, Barnes EL, Myeres EN et al (1981) The extracapusular spread of tumors in cervical node metastasis. Arch Otolaryngol 107:725–729

    Article  CAS  PubMed  Google Scholar 

  33. Carter RL (1993) The pathologist’s appraisal of neck dissection. Eur Arch Otorhinolaryngol 250:429–431

    Article  CAS  PubMed  Google Scholar 

  34. Carter RL, Barr LC, O’Brien CJ (1985) Transcapsular spread of metastatic squamous cell carcinoma. Am J Surg 150:495–499

    Article  CAS  PubMed  Google Scholar 

  35. Spiro RH, Alfonso AE, Farr HW et al (1974) Cervical node metastasis from epidermoid carcinoma of the oral cavity and oropharynx. A critical assessment of current staging. Am J Surg 128:562–567

    Article  CAS  PubMed  Google Scholar 

  36. Mendelson BC, Woods JE, Beahrs OH (1976) Neck dissection in the treatment of carcinoma of the anterior two thirds of the tongue. Surg Gynecol Obstet 143:75–80

    CAS  PubMed  Google Scholar 

  37. Crile G (1906) Excision of cancer of the head and neck. With special reference to the plan of dissection based on one hundred and thirty-two operation. JAMA 47:1780–1786

    Article  Google Scholar 

  38. Martin H, Del Valle B, Ehrlich H et al (1951) Neck dissection. Cancer 4:441–449

    Article  CAS  PubMed  Google Scholar 

  39. Robbins KT, Medina JE, Wolfe GT et al (1991) Standardizing neck dissection terminology. Official report of the academy’s committee for head and neck surgery and oncology. Arch Otolaryngol Head Neck Surg 117:601–605

    Article  CAS  PubMed  Google Scholar 

  40. Byers RM, El-Naggar AK, Lee YY et al (1998) Can we detect or predict the presence of occult nodal metastases in patients with squamous cell carcinoma of the tongue? Head Neck 20:138–144

    Article  CAS  PubMed  Google Scholar 

  41. Spiro RH, Huvos AG, Wong GY et al (1986) Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth. Am J Surg 152:345–350

    Article  CAS  PubMed  Google Scholar 

  42. Rubio Bueno P, Naval Gias L, Garcia Delgado R et al (1998) Tumor DNA content as a prognostic indicator in squamous cell carcinoma of the oral cavity and tongue base. J Sci Spec Head Neck 20:232–239

    Article  CAS  Google Scholar 

  43. Fagan JJ, Collins B, Barnes L et al (1998) Perineural invasion in squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 124:637–640

    Article  CAS  PubMed  Google Scholar 

  44. Woolgar JA, Scott J (1995) Prediction of cervical lymph node metastasis in squamous cell carcinoma of the tongue/floor of mouth. J Sci Spec Head Neck 17:463–472

    Article  CAS  Google Scholar 

  45. Yamamoto E, Miyakawa A, Kohama G (1984) Mode of invasion and lymph node metastasis in squamous cell carcinoma of the oral cavity. Head Neck 6:938–947

    Article  CAS  Google Scholar 

  46. Bryne M, Koppang HS, Lilleng R et al (1992) Malignancy grading of deep invasive margins of oral squamous cell carcinomas has high prognostic value. J Pathol 166:375–381

    Article  CAS  PubMed  Google Scholar 

  47. Shasha D, Harisson LB (1998) Elective irradiation of the N0 neck in squamous cell carcinoma of the upper aerodigestive tract. Otolaryngol Clin North Am 31:803–813

    Article  CAS  PubMed  Google Scholar 

  48. Andersen PE, Cambronero E, Shaha AR et al (1996) The extent of neck disease after regional failure during observation of the N0 neck. Am J Surg 172:689–691

    Article  CAS  PubMed  Google Scholar 

  49. Weiss MH, Harrison LB, Isaacs RS (1994) Use of decision analysis in planning a management strategy for the stage N0 neck. Arch Otolaryngol Head Neck Surg 120:699–702

    Article  CAS  PubMed  Google Scholar 

  50. Greenberg JS, El Naggar AK, Mo V et al (2003) Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma. Implication for therapeutic decision making. Cancer 98:508–515

    Article  PubMed  Google Scholar 

  51. Ferlito A, Silver CE, Rinaldo A (2009) Elective management of the neck in oral cavity squamous carcinoma: current concepts supported by prospective studies. Br J Oral Maxillofac Surg 47:5–9

    Article  PubMed  Google Scholar 

  52. Fletcher GH (1972) Elective irradiation of subclinical disease in cancers of the head and neck. Cancer 29:1450–1454

    Article  CAS  PubMed  Google Scholar 

  53. Mendenhall WM, Million RR, Cassisi NJ (1980) Elective neck irradiation in squamous-cell carcinoma of the head and neck. Head Neck 3:15–20

    Article  CAS  Google Scholar 

  54. Byers RM, Wolf PF, Ballantyne AJ (1988) Rationale for elective modified neck dissection. Head Neck 10:160–167

    Article  CAS  Google Scholar 

  55. Byers RM (1985) Modified neck dissection: a study of 967 cases from 1970 to 1980. Am J Surg 150:414–421

    Article  CAS  PubMed  Google Scholar 

  56. Traynor SJ, Cohen JI, Gray J et al (1996) Selective neck dissection and the management of the node-positive neck. Am J Surg 172: 654–657

    Article  CAS  PubMed  Google Scholar 

  57. Amdur RJ, Parson JT, Mendenhall WM et al (1989) Postoperative irradiation for squamous cell carcinoma of the head and neck: An analysis of treatment results and complications. Int J Radiat Oncol Biol Phys 16:25–36

    Article  CAS  PubMed  Google Scholar 

  58. Bernier J, Domenge C, Ozsahin M et al (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945–1952

    Article  CAS  PubMed  Google Scholar 

  59. Cooper JS, Pajak TF, Forastiere AA et al (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:1937–1944

    Article  PubMed  Google Scholar 

  60. Peters LJ, Goepfert H, Ang KK et al (1993) Evaluation of the dose for postoperative radiation therapy of head and neck cancer: First report of a postoperative randomized trial. Int J Radiat Oncol Biol Phys 26:3–11

    Article  CAS  PubMed  Google Scholar 

  61. Huang J, Barbera L, Brouwers M et al (2003) Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 21:555–563

    Article  PubMed  Google Scholar 

  62. Mastronikolis NS, Fitzgerald D, Owen C et al (2005) The management of squamous cell carcinoma of the neck. The Birmingham UK experience. Eur J Surg Oncol 31:461–466

    Article  CAS  PubMed  Google Scholar 

  63. Chan SW, Mukesh BN, Sizeland A et al (2003) Treatment outcome of N3 nodal head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg 129:55–60

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Tokyo Medical and Dental University, Tokyo, Japan

    Ken Omura D.D.S., Ph.D.

  2. Oral Cancer Center, Tokyo General Hospital, Tokyo, Japan

    Ken Omura D.D.S., Ph.D.

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  1. Ken Omura D.D.S., Ph.D.
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Correspondence to Ken Omura D.D.S., Ph.D. .

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Editors and Affiliations

  1. Dept of Oral and Maxillofacial Surg, Nara Medical University, Kashihara, Nara, Japan

    Tadaaki Kirita

  2. Oral Cancer Center, Tokyo General Hospital, Tokyo, Tokyo, Japan

    Ken Omura

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Omura, K. (2015). Management of the Neck. In: Kirita, T., Omura, K. (eds) Oral Cancer. Springer, Tokyo. https://doi.org/10.1007/978-4-431-54938-3_8

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  • DOI: https://doi.org/10.1007/978-4-431-54938-3_8

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