Oral Maxillary Squamous Cell Carcinoma: Management of the Clinically Negative Neck

David M. Montes, Brian Schmidt

Research output: Contribution to journalArticle

Abstract

Purpose: Squamous cell carcinomas of the hard palate, maxillary gingiva, and maxillary alveolus occur at relatively low rates compared with squamous cell carcinomas in other oral sites. There is little within the surgical literature to guide treatment for maxillary squamous cell carcinoma. To date, only 1 other group has addressed neck management in the oral maxillary squamous cell carcinoma patient presenting with a clinically negative neck. Adequate characterization of maxillary gingival carcinoma behavior with respect to regional cervical metastasis is wanting. Patients and Methods: We present a retrospective review of our own clinical experience as well as a review of the existing literature. Results: In our University of California San Francisco patient group, cervical disease was detected in 20% of those individuals with maxillary squamous cell carcinoma presenting for initial consultation. After ablative surgery, those individuals who presented with clinically negative necks had a 21.4% rate of regional node metastasis. Ultimately, 50% of our patients with squamous cell carcinomas of the palate, maxillary gingiva, and maxillary alveolus developed regional or metastatic distant disease; 42.9% of the patients manifested disease to the cervical lymph nodes alone. Conclusions: The cases of oral maxillary squamous cell carcinomas reviewed herein exhibit aggressive regional metastatic behavior comparable to that of such carcinomas of the tongue, floor of the mouth, and mandibular gingiva. Based on the findings presented herein, we recommend selective neck dissection in the setting of a clinically negative neck as a primary management strategy for patients with oral maxillary squamous cell carcinomas involving the palate, maxillary gingiva, and maxillary alveolus.

Original languageEnglish (US)
Pages (from-to)762-766
Number of pages5
JournalJournal of Oral and Maxillofacial Surgery
Volume66
Issue number4
DOIs
StatePublished - Apr 2008

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Squamous Cell Carcinoma
Neck
Gingiva
Palate
Neoplasm Metastasis
Carcinoma
Hard Palate
Mouth Floor
Neck Dissection
San Francisco
Tongue
Referral and Consultation
Lymph Nodes

ASJC Scopus subject areas

  • Dentistry(all)
  • Surgery

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Oral Maxillary Squamous Cell Carcinoma : Management of the Clinically Negative Neck. / Montes, David M.; Schmidt, Brian.

In: Journal of Oral and Maxillofacial Surgery, Vol. 66, No. 4, 04.2008, p. 762-766.

Research output: Contribution to journalArticle

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abstract = "Purpose: Squamous cell carcinomas of the hard palate, maxillary gingiva, and maxillary alveolus occur at relatively low rates compared with squamous cell carcinomas in other oral sites. There is little within the surgical literature to guide treatment for maxillary squamous cell carcinoma. To date, only 1 other group has addressed neck management in the oral maxillary squamous cell carcinoma patient presenting with a clinically negative neck. Adequate characterization of maxillary gingival carcinoma behavior with respect to regional cervical metastasis is wanting. Patients and Methods: We present a retrospective review of our own clinical experience as well as a review of the existing literature. Results: In our University of California San Francisco patient group, cervical disease was detected in 20{\%} of those individuals with maxillary squamous cell carcinoma presenting for initial consultation. After ablative surgery, those individuals who presented with clinically negative necks had a 21.4{\%} rate of regional node metastasis. Ultimately, 50{\%} of our patients with squamous cell carcinomas of the palate, maxillary gingiva, and maxillary alveolus developed regional or metastatic distant disease; 42.9{\%} of the patients manifested disease to the cervical lymph nodes alone. Conclusions: The cases of oral maxillary squamous cell carcinomas reviewed herein exhibit aggressive regional metastatic behavior comparable to that of such carcinomas of the tongue, floor of the mouth, and mandibular gingiva. Based on the findings presented herein, we recommend selective neck dissection in the setting of a clinically negative neck as a primary management strategy for patients with oral maxillary squamous cell carcinomas involving the palate, maxillary gingiva, and maxillary alveolus.",
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