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Occult lymph node metastases posterior to the internal jugular vein
D Godden1, C Cardozo, R Prescott
1Maxillofacial Surgery, Blackburn Royal Infirmary, Blackburn, Lancs, UK.
The British Journal of Oral & Maxillofacial Surgery
|June 11, 2002
Summary
Supraomohyoid neck dissection accurately stages oral cancer. Sampling the posterior strip in neck dissections identifies occult metastases, improving treatment accuracy for squamous cell carcinoma.
Area of Science:
- Head and Neck Surgery
- Surgical Oncology
- Oral and Oropharyngeal Squamous Cell Carcinoma
Background:
- Supraomohyoid neck dissection is a standard staging procedure for oral and oropharyngeal squamous cell carcinoma without clinical lymph node metastasis.
- The fibro-fatty tissue posterior to the internal jugular vein and beneath the sternomastoid muscle is a potential site for occult lymph node metastases.
Purpose of the Study:
- To evaluate the yield and distribution of occult lymph node metastases within the posterior strip during supraomohyoid neck dissection.
- To determine the clinical significance of including the posterior strip in the dissection for accurate cancer staging and treatment planning.
Main Methods:
- Conducted 35 supraomohyoid neck dissections in patients with oral or oropharyngeal squamous cell carcinoma and no clinical evidence of node metastases.
- Recorded the presence and location of occult lymph node metastases, specifically analyzing the fibro-fatty strip posterior to the internal jugular vein.
Main Results:
- Occult lymph node metastases were identified in 12 out of 35 (34%) dissections.
- Three of these cases (3/12) had metastases in the posterior strip, and these were never isolated findings.
- Inclusion of the posterior strip ensures removal of potentially missed tumor and aids in targeted radiotherapy.
Conclusions:
- Sampling the posterior strip during supraomohyoid neck dissection is valuable for detecting occult lymph node metastases in oral and oropharyngeal squamous cell carcinoma.
- This approach improves staging accuracy and allows for more precise targeting of postoperative radiotherapy to the anterior triangle when the posterior strip is clear.
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