Level IIb Neck Dissection in Oral Cavity Cancers- When Should One Address it..?

Abstract

Nodal metastases is the most important prognostic marker for oral cavity cancers. Nodal dissection at level IIb risks damage to the spinal accessory nerve. We aim to study positivity of level IIb lymph nodes in oral cancers. In this non-randomized prospective observational study, 65 patients of oral cavity cancers were evaluated. Appropriate surgery for primary tumour and neck dissection were undertaken. All patients underwent level II b dissection. Out of 67 neck dissections (27 elective and 40 therapeutic), 7 patients had level IIb positive for metastases (10.44%) with no isolated or contralateral metastases at level IIb and direct correlation with level IIa nodes. There was no statistical association of level IIb positivity with stage or site of primary. Level IIb dissection can be avoided in N0 necks. For therapeutic neck dissections, Level IIb should be cleared if there are positive nodes at level IIa.