The submandibular gland in neck dissection: A necessary casualty or a hapless victim?

Oral Oncology ◽  
2022 ◽  
Vol 125 ◽  
pp. 105678
Author(s):  
Yash P. Merchant ◽  
Mathan Mohan ◽  
Sameep Shetty ◽  
Mahesh Bandemegal ◽  
Lohith Reddy ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Submandibular Gland

scholarly journals Impact of submandibular gland preservation in neck management of early-stage buccal squamous cell carcinoma on locoregional control and disease-specific survival

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bo Gu ◽  
Qigen Fang ◽  
Yao Wu ◽  
Wei Du ◽  
Xu Zhang ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Cell Carcinoma ◽  
Neck Dissection ◽  
Submandibular Gland ◽  
Squamous Cell ◽  
Locoregional Control ◽  
Disease Specific Survival ◽  
The Difference ◽  
Disease Specific

Abstract Background The feasibility of submandibular gland (SMG) preservation in oral squamous cell carcinoma (SCC) has occasionally been analyzed, but the differences in survival associated with the presence or absence of SMG preservation remain unknown. We aimed to prospectively evaluate the oncologic results of SMG preservation in cT1-2 N0 buccal SCC. Methods This was a prospective, non-randomized cohort study. Patients with surgically treated cT1-2 N0 buccal SCC were prospectively enrolled and divided into two groups based on the management of the SMG. Level 1b lymph nodes were categorized into six groups based on the positional relationship between the lymph node and the SMG. The main study endpoints were locoregional control (LRC) and disease-specific survival (DSS). Results A total of 31 of the 137 included patients underwent SMG-sparing neck dissection. Patients with SMG preservation were likely to be young persons. Superior metastasis occurred in 11 patients with a prevalence of 8.0%, followed by an anterior metastasis rate of 5.1%, and no metastases developed deeply or within the SMG. The 5-year LRC rates in the SMG-sparing and SMG-excision groups were 74 and 75%, respectively, and the difference was not significant (p = 0.970). The 5-year DSS rates in the SMG-sparing and SMG-excision groups were 74 and 69%, respectively, and the difference was not significant (p = 0.709). Conclusions SMG involvement was rare, and the superior group carried the highest risk for lymph node metastasis. SMG-sparing neck dissection is selectively suggested in cT1-2 N0 buccal SCC patients, and could avoid postoperative asymmetric appearance and dry mouth.

Feasibility of Preservation of the Submandibular Gland During Neck Dissection in Patients With Early-Stage Oral Cancer

2010 ◽  
Vol 18 (2) ◽  
pp. 497-504 ◽  
Author(s):  
Tseng-Cheng Chen ◽  
Pei-Jen Lou ◽  
Jenq-Yuh Ko ◽  
Tsung-Lin Yang ◽  
Wu-Chia Lo ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Neck Dissection ◽  
Submandibular Gland ◽  
Early Stage

scholarly journals Level I Nodal Positivity as a Factor for Involvement of the Submandibular Gland in Oral Cavity Carcinoma: A Case Series Report

2020 ◽  
Author(s):  
Hamdan Ahmed Pasha ◽  
Rahim Dhanani ◽  
Shayan Khalid Ghaloo ◽  
Kulsoom Ghias ◽  
Mumtaz Jamshed Khan
Keyword(s):  
Oral Cavity ◽  
Lymph Nodes ◽  
Neck Dissection ◽  
Submandibular Gland ◽  
Primary Tumor ◽  
Oral Carcinoma ◽  
Care Hospital ◽  
Direct Extension ◽  
Oral Cavity Carcinoma ◽  
Level I

Abstract Introduction The routine practice of neck dissection in the surgical management of oral carcinoma has evolved into a more functionally conservative approach. Over time, the rationale for removal of the submandibular gland has been questioned. Routine extirpation of the submandibular gland can aggravate the xerostomia experienced by many patients, significantly affecting their quality of life. Objective The objective of the present study was to determine the incidence of submandibular gland metastases in oral cavity carcinoma and to identify possible factors that may affect their involvement. Methods A total of 149 cases of oral carcinoma presenting at a private tertiary care hospital in Karachi, Pakistan, over the course of 1 year were reviewed retrospectively. Results Histopathological data showed that the submandibular gland was involved in 7 (4.7%) cases. Involvement of level I lymph nodes was found in all of the cases. Direct extension of primary tumor was noted in two cases when the primary tumor was in the floor of the mouth. Conclusion The results suggest that preservation of the submandibular gland during neck dissection for oral carcinoma can be practiced safely when there is no evidence of direct extension of the primary tumor toward the submandibular gland or when there is no clinical or radiological evidence of neck disease in level I. Presence of pathological lymph nodes in level I requires caution when contemplating preservation of the submandibular gland.

Does Submandibular Gland Sacrificing Neck Dissection Decrease Salivary Output and Quality of Life?

ORL ◽  
2021 ◽  
Vol 83 (5) ◽  
pp. 341-346
Author(s):  
Ozan Muzaffer Altuntaş ◽  
Furkan Özer ◽  
Oğuz Kuşçu ◽  
Nilda Süslü
Keyword(s):  
Quality Of Life ◽  
Neck Dissection ◽  
Submandibular Gland ◽  
Control Group ◽  
Adjuvant Radiation ◽  
Related Quality ◽  
Level I ◽  
Saxon Test ◽  
The Impact

<b><i>Purpose:</i></b> Our study aimed to quantify the impact of submandibular gland (SMG) resection during Level I neck dissection (ND) on stimulated salivary output (SSO) and xerostomia-related quality of life in patients with head and neck cancer (HNC). <b><i>Methods:</i></b> A retrospective cohort was formed from 32 patients that underwent unilateral or bilateral Level I ND and a control group of 23 patients that had level II–IV ND. SSO (Saxon test) and University of Washington Quality of Life survey results for both groups were compared. <b><i>Results:</i></b> Mean SSO was 3.41 g in the SMG resection group and 3.86 g in the control group, with no significant statistical difference. There was no difference in mean SSO between patients with 2 SMGs, a single remaining SMG, or no glands. The mean SSO of SMG resection cases with a history of adjuvant RT was 2.61 g which was below the xerostomia threshold for the Saxon test (2.75 g) and control group patients with RT had a significantly higher mean SSO (4.07 g). The lowest UW-QoL saliva domain score average (53.8) was in the SMG-resected, RT-positive group. <b><i>Conclusion:</i></b> Results indicate unilateral or bilateral resection of SMG does not reduce SSO to a significant extent. Adjuvant radiotherapy and SMG resection are additive risk factors for xerostomia and the related loss in quality of life. SMG sparing may be necessary in HNC patients with higher risk for the need of adjuvant radiation.

Is it oncologically safe to leave the ipsilateral submandibular gland during neck dissection for head and neck squamous cell carcinoma?

2011 ◽  
Vol 125 (8) ◽  
pp. 837-840 ◽  
Author(s):  
A K Ebrahim ◽  
J W Loock ◽  
A Afrogheh ◽  
J Hille
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Neck Dissection ◽  
Submandibular Gland ◽  
Squamous Cell ◽  
Perineural Invasion ◽  
Primary Tumour ◽  
Tumour Stage ◽  
Node Metastasis

AbstractAim:To investigate the incidence of metastasis to the submandibular gland in patients with head and neck squamous cell carcinoma.Methods:We retrospectively evaluated histological reports of neck dissections for upper respiratory tract carcinoma (performed 2002–2009), recording: primary tumour site, tumour–node–metastasis stage, level Ib involvement, previous radiotherapy, perineural invasion, lymphovascular invasion, extracapsular spread, and the presence of malignant disease in the submandibular gland.Results:We evaluated 107 cases. The most common primary site was the oral cavity (49 per cent) followed by the supraglottis (21 per cent), glottis (14 per cent), oropharynx (9 per cent) and hypopharynx (6 per cent). Forty-eight per cent of patients had advanced local disease, with 21 per cent at tumour stage 3 and 27 per cent at tumour stage 4. Fifty-six per cent had cervical lymph node metastasis, and 8 per cent received pre-operative radiotherapy. Forty-eight per cent had perineural invasion, 46 per cent lymphovascular spread, 27 per cent extracapsular spread and 8 per cent level Ib metastasis. Only one patient had submandibular gland involvement, due to direct spread (a case with prior radiotherapy and macroscopic submandibular gland involvement evident peri-operatively).Conclusion:Submandibular gland metastasis from head and neck primary squamous cell carcinoma is extremely rare. Preservation of the ipsilateral submandibular gland during neck dissection is oncologically safe, except in patients with prior surgery or radiotherapy, or a primary tumour in close relation to the gland.

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