Occult lymph node metastases posterior to the internal jugular vein

Supraomohyoid neck dissection is a reliable staging procedure in patients with oral or oropharyngeal squamous cell carcinoma and no clinical evidence of node metastases. We have recorded the yield and distribution of occult lymph node metastases in the fibro-fatty strip of tissue posterior to the internal jugular vein and beneath the sternomastoid in 35 neck dissections. Occult lymph node metastases were found in 12/35 (34%); 3 of these had metastases in the posterior strip, which were never in isolation. We think that it is worthwhile to sample the posterior strip. Firstly it removes tumour that would have been left behind in a small number of cases had a conventional supraomohyoid neck dissection been done, and secondly it enables postoperative radiotherapy to be targeted at the anterior triangle alone when the posterior strip is clear of tumour.