Sentinel node biopsy in floor of mouth cancers: the need to clear level I

Tumour lymphatic spread in head and neck squamous cell carcinomas is the single most important prognostic indicator. With advances in histological examination, sentinel node biopsy is proving to be an accurate method for staging the clinically N0 neck. We have previously highlighted the difficulties in locating sentinel nodes in the neck from floor of mouth primaries. We also raised the question whether level I nodes should be cleared as part of sentinel node procedures in floor of mouth tumours. We describe a case which illustrates the difficulties encountered when performing sentinel node biopsies in patients with floor of mouth cancers and the rationale behind asking such a question.