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Updated: Jun 5, 2026
Modified Radical Neck Dissection for Cervical Metastasis
Published on: February 20, 2026
Management of cervical lymph node metastasis in tonsillar squamous cell carcinoma: Is it necessary to treat
Kwang Jae Cho1, Young Hoon Joo, Dong Il Sun
1Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Objective:
To investigate the appropriate management of cervical lymph node metastasis in patients with tonsillar squamous cell carcinoma (SCC).
Methods:
The medical records of 49 patients that were surgically treated for tonsillar SCC were evaluated. Preoperative and postoperative stages, clinical factors affecting the nodal metastasis, and its relationship with survival were examined.
Results:
Among 49 ipsilateral neck dissection (ND) specimens, 34 neck specimens (69%) were pN+. Out of 17 cases that underwent ipsilateral elective NDs, 4 cases (24%) were found to have pN+ necks. The disease-specific survival of the 34 patients with pN+ necks and 4 patients with occult metastases was worse than that of the remaining patients with pN0 necks and without occult metastasis, respectively (p=0.049 and p=0.023, respectively). All cases (100%) that underwent contralateral therapeutic NDs had pN+ findings. Two out of the 21 cases (less than 10%) that underwent contralateral elective NDs turned out to have pN+ necks and did not show any difference in survival compared to the 19 cases with pN0 necks. The degree of differentiation was associated with contralateral nodal metastasis.
Conclusion:
Patients with tonsillar SCC require thorough ipsilateral neck treatment because of the high probability of nodal metastasis and the close association between lymph node metastasis and survival. The contralateral cN+ neck should also be treated; however, the contralateral cN0 neck might be preserved with caution on the cases with poorly differentiated primary tumors and/or ipsilateral cN+ necks.
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It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...