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Abstract: When dealing with patients who have head and neck cancer - squamous cell carcinoma and have clinically N0 neck disease it is very difficult to assess the real extension of the malignant proccess. This is why several techniques are curently in use to determine the actual TNM clasiffication for each patient in order to apply best suited therapy management. Up until today the staging of the neck has been done by using a combination of the physical exam and conventional imaging studies. Recent studies and research have tried to determine weather the use of sentinel lymph node biopsy is a more reliable tool in predicting occult metastasis in cancer patients with clinically N0 neck disease. There are no guidelines in this matter and as such the use of the sentinel lymph node detection technique is yet to be used on a routine basis. The authors are trying to assess the benefits of different paraclinical investigation regarding the improvement of overall survival rates in patients with T1/T2 squamous cell carcinoma of the head and neck and N0 neck disease.

Head and neck cancers account for less than 5% of all cancers worldwide and for less than 1% of all cancer deaths in Romania. Sinonasal squamous cell carcinomas are malignant tumors with origin in the respiratory mucosa of the paranasal sinuses and the nasal cavity. Because of the proximity to different important structures such as the brain, the eye the relevance of a multimodal therapy is well known. We take into discussion not only the most recent data from novel agents targeting EGF receptor (EGFR), VEGF and p53 pathways for the management of sinonasal cancer, but also further development of multimodal approach, and the use of biomarkers to appreciate the progression of the disease and the prognostic and overall survival rate in clinical practice. EGFR alterations have been implicated in the pathogenesis and progression of many malignancies. EGFR overexpression has been studied extensively regarding its clinical use but the results are yet to be analyzed.

Although rare, sinonasal malignancies (SNM) can be lesions of immense importance. Approximately 60-70% of sinonasal malignancies (SNM) occur in the maxillary sinus and 20-30% occurs in the nasal cavity itself. The lymphatic drainage of the sinuses and nasal cavity include levels I-III as well as the parapharyngian nodes. Elective regional lymph node dissections became controversial because of overtreatment of the many patients without lymph node metastases. Lymphatic metastasis is the most important mechanism of spread in sinonasal squamous cell carcinoma considering the vast network of vessels in this area. The indications and type of neck dissection to be performed in the positive node neck and management of the N0 neck remain controversial. The sentinel lymph node concept is based on the Halsted theory that stressed the importance of locoregional cancer treatment because of the far site spread. Each patient with head and neck malignancies, including sinonasal carcinoma have about 2-3 sentinel lymph nodes of which up to 40% of them contain metastases.