Management of the N0 Neck in Oral Squamous Cell Carcinoma

Allen Cheng, Brian Schmidt

Research output: Contribution to journalArticle

Abstract

Oral squamous cell carcinoma (SCC) has an unpredictable capacity to metastasize to the neck, an event that dramatically worsens prognosis. Metastasis occurs even in earlier stages when no neck lymph node involvement is clinically detectable (N0). Management of the N0 neck, namely when and how to electively treat, has been debated extensively. This article presents the controversies surrounding management of the N0 neck, and the benefits and pitfalls of different approaches used in evaluation and treatment. As current methods of assessing the risk for occult metastasis are insufficiently accurate and prone to underestimation of actual risk, and because selective neck dissection (SND) is an effective treatment and has minimal long-term detriment to quality of life, the authors believe that all patients who have oral SCC, excluding lip SCC, should be prescribed elective treatment of the neck lymphatics. However, this opinion remains controversial. Because of the morbidity of radiation therapy and because treatment of the primary tumor is surgical, elective neck dissection is the preferred treatment. In deciding the extent of the neck dissection, several retrospective studies and one randomized clinical trial have shown SND of levels I through III to be highly efficacious.

Original languageEnglish (US)
Pages (from-to)477-497
Number of pages21
JournalOral and Maxillofacial Surgery Clinics of North America
Volume20
Issue number3
DOIs
StatePublished - Aug 2008

Fingerprint

Neck Dissection
Squamous Cell Carcinoma
Neck
Neoplasm Metastasis
Therapeutics
Lip
Radiotherapy
Randomized Controlled Trials
Retrospective Studies
Lymph Nodes
Quality of Life
Morbidity
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Dentistry(all)

Cite this

Management of the N0 Neck in Oral Squamous Cell Carcinoma. / Cheng, Allen; Schmidt, Brian.

In: Oral and Maxillofacial Surgery Clinics of North America, Vol. 20, No. 3, 08.2008, p. 477-497.

Research output: Contribution to journalArticle

@article{acee470e38f7405d9a624bcb41bcb652,
title = "Management of the N0 Neck in Oral Squamous Cell Carcinoma",
abstract = "Oral squamous cell carcinoma (SCC) has an unpredictable capacity to metastasize to the neck, an event that dramatically worsens prognosis. Metastasis occurs even in earlier stages when no neck lymph node involvement is clinically detectable (N0). Management of the N0 neck, namely when and how to electively treat, has been debated extensively. This article presents the controversies surrounding management of the N0 neck, and the benefits and pitfalls of different approaches used in evaluation and treatment. As current methods of assessing the risk for occult metastasis are insufficiently accurate and prone to underestimation of actual risk, and because selective neck dissection (SND) is an effective treatment and has minimal long-term detriment to quality of life, the authors believe that all patients who have oral SCC, excluding lip SCC, should be prescribed elective treatment of the neck lymphatics. However, this opinion remains controversial. Because of the morbidity of radiation therapy and because treatment of the primary tumor is surgical, elective neck dissection is the preferred treatment. In deciding the extent of the neck dissection, several retrospective studies and one randomized clinical trial have shown SND of levels I through III to be highly efficacious.",
author = "Allen Cheng and Brian Schmidt",
year = "2008",
month = "8",
doi = "10.1016/j.coms.2008.02.002",
language = "English (US)",
volume = "20",
pages = "477--497",
journal = "Oral and Maxillofacial Surgery Clinics of North America",
issn = "1042-3699",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - Management of the N0 Neck in Oral Squamous Cell Carcinoma

AU - Cheng, Allen

AU - Schmidt, Brian

PY - 2008/8

Y1 - 2008/8

N2 - Oral squamous cell carcinoma (SCC) has an unpredictable capacity to metastasize to the neck, an event that dramatically worsens prognosis. Metastasis occurs even in earlier stages when no neck lymph node involvement is clinically detectable (N0). Management of the N0 neck, namely when and how to electively treat, has been debated extensively. This article presents the controversies surrounding management of the N0 neck, and the benefits and pitfalls of different approaches used in evaluation and treatment. As current methods of assessing the risk for occult metastasis are insufficiently accurate and prone to underestimation of actual risk, and because selective neck dissection (SND) is an effective treatment and has minimal long-term detriment to quality of life, the authors believe that all patients who have oral SCC, excluding lip SCC, should be prescribed elective treatment of the neck lymphatics. However, this opinion remains controversial. Because of the morbidity of radiation therapy and because treatment of the primary tumor is surgical, elective neck dissection is the preferred treatment. In deciding the extent of the neck dissection, several retrospective studies and one randomized clinical trial have shown SND of levels I through III to be highly efficacious.

AB - Oral squamous cell carcinoma (SCC) has an unpredictable capacity to metastasize to the neck, an event that dramatically worsens prognosis. Metastasis occurs even in earlier stages when no neck lymph node involvement is clinically detectable (N0). Management of the N0 neck, namely when and how to electively treat, has been debated extensively. This article presents the controversies surrounding management of the N0 neck, and the benefits and pitfalls of different approaches used in evaluation and treatment. As current methods of assessing the risk for occult metastasis are insufficiently accurate and prone to underestimation of actual risk, and because selective neck dissection (SND) is an effective treatment and has minimal long-term detriment to quality of life, the authors believe that all patients who have oral SCC, excluding lip SCC, should be prescribed elective treatment of the neck lymphatics. However, this opinion remains controversial. Because of the morbidity of radiation therapy and because treatment of the primary tumor is surgical, elective neck dissection is the preferred treatment. In deciding the extent of the neck dissection, several retrospective studies and one randomized clinical trial have shown SND of levels I through III to be highly efficacious.

UR - http://www.scopus.com/inward/record.url?scp=46149090853&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=46149090853&partnerID=8YFLogxK

U2 - 10.1016/j.coms.2008.02.002

DO - 10.1016/j.coms.2008.02.002

M3 - Article

VL - 20

SP - 477

EP - 497

JO - Oral and Maxillofacial Surgery Clinics of North America

JF - Oral and Maxillofacial Surgery Clinics of North America

SN - 1042-3699

IS - 3

ER -