The role of neck dissection in cancer of the oral cavity

Abstract

Carcinoma of the oral cavity is most often treated by surgical resection, is associated with clinically evident neck disease in one third of cases, and has a high rate of occult metastasis in the N₀ neck. When patients have clinically evident neck disease, comprehensive neck dissection is usually performed. Establishing an approach to the N₀ neck has been somewhat more difficult and controversial. The presence of occult neck metastasis carries both prognostic and therapeutic implications. The most reliable factor in determining the presence of metastasis is pathological evaluation; this is the rationale for performing staging neck dissections in patients with tumors of the oral cavity. Since two-thirds of these dissections will yield no tumor, the type of neck dissection should yield the most prognostic information while causing the least morbidity. A selective neck dissection encompassing Levels I-III satisfies these requirements well.