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Introduction The harmonic scalpel (HS) is a technique introduced to reduce blood loss and intraoperative time during neck dissection (ND).

Abstract Background Locoregional recurrence is a critical factor in the prognosis of sinonasal malignancies. Due to the rarity of these tumours, as well as the heterogeneity of histologies and anatomical subsites, there is little evidence regarding the rate and location of regional metastases in sinonasal malignancies. Elective regional lymph node dissection in the therapy of sinonasal malignancies has become controversial. On the one hand, elective regional lymph node dissection is considered to be an overtreatment in the cN0 cases. On the other hand, undetected occult lymphatic metastases are associated with a poor prognosis. In this study, we discuss the role of sentinel lymph node biopsy as a minimally invasive procedure in the treatment of sinonasal malignancies based on our two years of practical experience and the currently available data. Results This is a descriptive, monocentric, retrospective study, including 20 cases of cN0 malignant sinonasal neoplasm, that underwent a surgical therapy between 2020 and 2022. The following aspects were investigated: tumour entity, localisation of the primary tumour, tumoral stage, localisation of the sentinel lymph nodes, and postoperative complications. Squamous cell carcinoma was the most frequently diagnosed tumour entity (50%), followed by adenocarcinoma (20%) and malignant melanoma (15%), adenoid cystic carcinoma and mucoepidermoid carcinoma. Sentinel lymph nodes were most frequently found in the ipsilateral neck region I (45%), followed by the ipsilateral neck region II (40%). In all cases, the removed lymph nodes were free of malignancy. There were no postoperative complications due to lymph node biopsy. There were no recurrences during the study period. Conclusion Sentinel node biopsy could add more safety to the management of cN0 sinonasal malignancies due to its low morbidity. Whether SNB could provide an alternative to elective neck dissection in the management of SNM should be investigated in further studies.

Abstract: Introduction: Neck dissection is an important surgical procedure to treat head-neck cancers. It also helps to stage the disease as well as denotes further treatment plan. Materials and Methods: A retrospective analytical study is done between August 2017-July 2021 in tertiary care hospital to identify methods and practices to reduce complications of neck dissection. 104 patients who met the selection criteria were reviewed. Any intraoperative as well as post-operative complication was carefully assessed and managed as per protocol. Results: 62.5% were in the age group of 49-59 years. 66.35% were male. Maximum patient (65.38%) presented with oral cavity squamous call carcinoma. 51.92% had N1 neck node while 44.23% had N0 neck node. Internal jugular vein injury, spinal accessory nerve and marginal mandibular nerve injury, post-operative hematoma, seroma formation, chyle leak were found as significant complications in initial days. They were less in number or managed well with experience. Conclusion: Detailed knowledge of head-neck anatomy, meticulous dissection technique, early detection of any complication and its management can decrease the long-term morbidity and improve patient’s quality of life. Keywords: Neck dissection, head-neck cancer, complication, meticulous haemostasis.

Introduction Clinical and pathological staging plays an important role on the prognosis of head and neck cancer (HNC) patients.

Background: Perioperative and postoperative pain control, maintenance of hemodynamic stability, proper sedation, and awakening form an integral part of anaesthetic management in head and neck surgeries. Opioids such as fentanyl are widely used for analgesia in routine anaesthetic practice. Newer non-opioid drugs such as dexmedetomidine are being increasingly used to facilitate the recovery process after surgery because of their anaesthetic and analgesic sparing effects. In this study, we compare the efficacy of dexmedetomidine and fentanyl infusion on intraoperative hemodynamic changes in neck dissection. Objectives: The aim of the study was to compare the efficacy of dexmedetomidine and fentanyl on intraoperative hemodynamic changes in neck dissection. Material and Methods: 60 male and female patients, ASA 1 and 2 aged 30–40 years scheduled for neck dissection surgeries under general anaesthesia were randomly allocated into two equal groups: Group D (n = 30) received a bolus dose of IV dexmedetomidine 1 μg/kg over 10 minutes before induction of anaesthesia and followed by infusion at the rate of 0.2 μg/kg/h during surgery. Group F (n = 30) received bolus dose of fentanyl 2 μg/kg before induction of anaesthesia and followed by infusion at the rate of 0.5 μg/kg/h during the surgery. General anaesthesia was induced in all patients using propofol and vecuronium. The following parameters were recorded: systolic blood pressure, mean arterial pressure and heart rate before and after induction of anaesthesia and then every 15 minutes till the end of surgery. Results: The intraoperative systolic blood pressure, mean arterial blood pressure and heart rate were statistically significantly (P < 0.05) lower in dexmedetomidine group compared to fentanyl group. Two patients had bradycardia in dexmedetomidine group and were responded injection atropine. Conclusion: The intravenous dexmedetomidine infusion provides stable intraoperative haemodynamics compared to fentanyl in neck dissection surgeries.

Objective To investigate the clinical manifestations, diagnostics, and treatment of chylothorax following neck dissection for oral cancer. Methods The clinical data of 3 patients with chylothorax after neck dissection for oral cancer from January 2020 to May 2021 in the Stomatological Center of Xiangya Hospital, Central South University, were retrospectively analyzed in detail, and the relevant literature was reviewed. The risk factors, clinical manifestations, diagnostics, treatment, and prognosis of chylothorax were summarized. Results The 3 patients were all male patients with oral cancer aged 42-63 years. Their clinical manifestations were progressive dyspnea 2-5 days after cervical lymphadenectomy. Chest X-ray, B-ultrasound, and/or CT showed unilateral or bilateral pleural effusion, and the diagnosis was confirmed after a positive chylous test of pleural puncture fluid. There was 1 case with left chylothorax (1 case after left neck dissection) and 2 cases with bilateral chylothorax (1 case after left neck dissection, 1 case after bilateral neck dissection). Severe neck chylous leakage occurred in 2 patients; local compression did not work, and the thoracic ducts were ligated. All patients were treated with nutritional support, assisted mechanical ventilation, tube thoracostomy drainage, and other conservative treatments. The chylothorax volume of each patient was gradually reduced, and the chest drainage tube was removed 7 to 15 days later. All patients recovered successfully. The literature review results showed that when patients with oral cancer after neck dissection experienced progressive dyspnea, related auxiliary examination methods such as chest X-ray, B-ultrasound, CT, and chyle tests should be used by clinicians. When a patient is diagnosed with chylothorax, they should be treated with nutritional support, mechanical ventilation, somatostatin, thoracic puncture drainage, other conservative treatments, and even thoracotomy and ligation of the thoracic duct surgery when necessary. Conclusion Chylothorax is a relatively rare complication after neck dissection for oral cancer. It mainly occurs bilaterally or only in the ipsilateral pleural cavity on the surgical side of neck dissection. Left neck dissection is a risk factor. The clinical manifestations are mostly progressive dyspnea after neck dissection. Detailed physical examination, chest X-ray, B ultrasound, and/or CT could detect pleural effusion, and chylothorax could be diagnosed when milky white or pale yellow chylous liquid is aspirated and the chylous test is positive. Most patients can be cured with tube thoracostomy drainage, respiratory support, and other conservative treatments.

ABSTRACT Objective: Cervical traumatic neuromas (CTNs) may appear after lateral neck dissection for metastatic thyroid carcinoma. If they are misdiagnosed as metastatic lymph nodes (LNs) in follow-up neck ultrasound (US), unnecessary and uncomfortable fine-needle aspiration biopsy are indicated. The present study aimed to describe US features of CTNs and to assess the US performance in distinguishing CTNs from abnormal LNs. Subjects and methods: Retrospective evaluation of neck US images of 206 consecutive patients who had lateral neck dissection as a part of thyroid cancer treatment to assess CTN’s US features. Diagnostic accuracy study to evaluate US performance in distinguishing CTNs from abnormal LNs was performed. Results: Eight-six lateral neck nodules were selected for analysis: 38 CTNs and 48 abnormal LNs. CTNs with diagnostic cytology were predominantly hypoechogenic (100% vs. 45%; P = 0.008) and had shorter diameters than inconclusive cytology CTNs: short axis (0.39 cm vs. 0.50 cm; P = 0.03) and long axis (1.64 cm vs. 2.35 cm; P = 0.021). The US features with the best accuracy to distinguish CTNs from abnormal LNs were continuity with a nervous structure, hypoechogenic internal lines, short/long axis ratio ≤ 0.42, absent Doppler vascularization, fusiform morphology, and short axis ≤ 0.48 cm. Conclusion: US is a very useful method for assessing CTNs, with good performance in distinguishing CTNs from abnormal LNs.

Background. An ocular adnexal apocrine adenocarcinoma (OAAA) is an extremely rare, but potentially aggressive and life-threatening tumor with ill-defined management based only on recommendations from a limited number of reported cases. The development of cervical lymphocele following neck dissection is a very rare complication, but one with well established methods for prevention and treatment. Here we describe a previously unreported case of salvage surgery including neck dissection for OAAA in addition to an emergence of cervical lymphocele. A literature review of current knowledge on both pathological conditions is included. Methods and Results. A 58-year-old man suffering from OAAA, previously treated with multiple eye-sparing excisions and adjuvant proton therapy, underwent salvage surgery for locoregional recurrence of the tumor. A partial orbitectomy with orbital exenteration, primary reconstruction and left-sided neck dissection was performed. The procedure was complicated by a cervical lymphocele resolved after the surgical therapy. The patient remained disease-free during the one-year follow-up. Conclusion. OAAA is a locally aggressive tumor with potential to local or distant metastatic spread. Whole-body staging, regular clinico-radiological follow-up and stage-dependent therapy with surgery as the first-choice treatment is required. A cervical lymphocele as a complication of especially left-sided neck dissection is managed with a conservative or surgical therapy according to the level of lymph leakage, extent and localization of lesions, presence of local or systemic disorders and the period from primary surgery.

Objectives The aim of this study was to compare the long-term oncologic outcomes of sentinel lymph node biopsy (SLNB) versus elective neck dissection (END) in clinically node-negative (cN0) tongue cancer. Methods This was a retrospective cohort study of patients with cN0 tongue cancer from a single institution, including 91 patients in the SLNB group and 120 patients in the END group. Results The overall recurrence rate showed no significant difference between the two groups. The regional control rate was also comparable between the two groups (P=0.490). The 5-year recurrence-free survival (RFS) was slightly better in the SLNB group than in the END group (P=0.427). The 5-year overall survival (OS) rate was 89.9% in the SLNB group versus 91.9% in the END group (P=0.737). In a propensity-matched subgroup analysis, the type of neck management did not affect RFS or OS. Conclusion SLNB showed non-inferior oncologic outcomes compared to END in patients with cN0 tongue squamous cell carcinoma.

Postoperative chyle leak is a rare but serious complication of head and neck surgery. Chyle leak can lead to a systemic metabolic imbalance, a prolonged wound healing and longer hospital stay. Early identification and treatment are crucial for good surgical outcome. The diagnosis can be made intraoperatively or in the early postoperative period. Various treatment options described in the literature can be divided into conservative and surgical modalities. Currently, there is no evidence that any approach is superior to the other due to relatively small number of studies describing chyle leak management. There are no official guidelines for the treatment of postoperative chyle leak. The aim of this article is to present the therapeutic possibilities and to offer an algorithm for chyle leak management.

Abstract Individual facial nerve branching patterns can be difficult to predict. The superficial course of its terminal branches poses them at risk of injury during head and neck surgeries. We report the rare course of a branch of the facial nerve deep into the posterior facial vein.

Introduction: Oral Squamous Cell Carcinoma (OSCC) is one of the most common malignant diseases of head and neck region. Management of OSCC involves removal of the Submandibular Gland (SMG) along with lymph nodes. The submandibular salivary gland is routinely removed, considering metastatic involvement from OSCC. Many studies showed there is no or rare involvement of the submandibular gland. Aim: To find the incidence of metastasis of oral squamous cell carcinoma in the submandibular salivary gland during neck dissection. Materials and Methods: This cross-sectional, observational, descriptive study will be conducted in the Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Sawangi, Maharashtra, India. The research started from November 2018. Data will be compilated in tabular form in term of descriptive statistics with frequency and proportion of submandibular gland involvement. It will be conducted on 90 operated cases of OSCC in whom one or both the submandibular glands will be removed during neck dissection. The outcome parameters will be the nature and site of lesion, clinical nodal status, clinical stage of disease, preoperative and postoperative histopathological examination of lesion, histopathological examination of resected lymph nodes and proportion of involvement of submandibular gland.

Objectives. The bilateral axillo-breast approach (BABA) to robotic thyroidectomy has been extended to modified radical neck dissection (MRND). This study assessed outcomes in patients who underwent robotic MRND through BABA using the da Vinci Xi system. Methods. The medical records of 40 patients who underwent total thyroidectomy, bilateral central neck dissection, and MRND from September 2018 to March 2020 were reviewed retrospectively, including 12 who underwent robotic surgery and 28 who underwent open surgery. All operations were performed by a single endocrine surgeon. Results. The operation time was significantly longer in the robotic group than in the open group (277.08±32.64 vs. 191.43± 60.43 minutes, respectively, P

Abstract Consideration of unexpected metastasis in patients who have undergone neck dissection with advanced tumors must be anticipated with careful follow‐up.

Aim:To evaluate the mid-term treatment results in early-stage squamous cell carcinoma (SCC) of the lower lip and to investigate the effect of tumor depth and size on neck metastasis.Methods:The study included 52 patients who were operated between 2010 and 2017 for early-stage primary SSC of the lip with negative surgical margins and without oral commissure involvement T1 and T2 without lymph node or distant metastasis. Patients with missing data or patients with a history of additional malignancy at the time of diagnosis were excluded from the study (n=13). The data of the remaining 39 patients were further analyzed.Results:Fifteen patients (38.5%) were identified as having pT1 and 24 patients (61.5%), pT2. The mean tumor size was 16.8 mm and the mean invasion depth was 6.3 mm. Neck dissection was performed in 22 (56.4%) patients (6/15 pT1 patients and 16/24 pT2 patients). Lymph node involvement was reported in two (9.09%) of 22 patients. Both patients had pT2 stage tumors. Recurrence was observed in one patient (patient with pT2 tumor). The 5-year survival rate was calculated as 82.05%.Conclusion:In early-stage SCC of the lower lip, a tumor size greater than 21.5 mm and depth of tumor invasion greater than 7 mm are associated with increased neck metastasis. Elective neck dissection should be performed in these high-risk patients.

Abstract Postsurgical pyoderma gangrenosum (PSPG) develops in the skin after surgery without known cause. Immunosuppression constitutes first‐line therapy and increases the likelihood of successful surgery when needed. PSPG should be considered when a flap necrosis occurs.

Background: Pharyngo-cutaneous fistula is a major complication of total laryngectomy. Despite its significant impact on the patients’ nutrition and management outcome, there is lack of consensus for recognising high-risk patients and factors associated with fistula formation. Hence, this study was aimed at determining the incidence of pharyngo- cutaneous fistula and factors associated with fistula formation. Methods: A retrospective collection of data on all cases of laryngeal cancer diagnosed histologically and had total laryngectomy, in the Otorhinolaryngology Department of a tertiary centre in Southwestern, Nigeria, from 2007 - 2016. The data collected includeage, gender, tumour stage, tracheostomy, adjuvant therapy extent of laryngectomy procedure and factors for pharyngo-cutaneous fistula. Results: Forty-two patients had total laryngectomy, male to female ratio was 7.4:1 and mean age was 52.3 ± 2.1 years. All patients had pathologicaldiagnosis of stage 3 (83.3%) and stage 4 (16.7%) laryngeal cancer, respectively. The incidence of pharyngo-cutaneous fistula was 11.9% and the factors related to fistula formation were prior radiotherapy treatment and diabetes. Age, gender, neck dissection procedures, site of primary tumor and emergency tracheostomy did not contribute to fistula formation. Spontaneous fistula closure was achieved in all cases except one patient who had surgical closure. Conclusion: Pharyngo-cutaneous fistula formation post-surgery is related to the presence of co-morbidities. The high percentage of spontaneous closure underscores the need for a conservative management approach.

Objective: To correlate the clinical lymph node classification with the pathological result of neck dissections performed in patients with head and neck cancer at the Otorhinolaryngology Department of the Hospital Universitario de Caracas from January 1, 2011 to December 31, 2016. Method: Descriptive, quantitative and retrospective study, which evaluated 27 patients, who underwent classical radical, modified radical and selective neck dissection. Results: average age 56 years, 77.8% male. The most frequent histological type was squamous carcinoma 81.5%. The most used type of dissection was selective 53.3%, followed by the classical radical 26.7% and the modified radical 20.0%, of these 36% presented local or cervical recurrence. Of the 16 patients with positive lymph nodes, 13 had patology confirmation, and all the negative nodes also had negative patology confirmation; regarding cervical recurrence, of the 7 cases where it was present, all positive nodes, and in the 11 patients negative nodes, all negative cervical recurrence. Conclusion: The relationship between the pathological and clinical classification, as well as the presence of positive lymph nodes in cervical recurrences are statistically significant and are related to the decrease in survival. Neck palpation continues to be a useful tool in therapeutic decision making, which has shown higher than average sensitivity and specificity.

Papillary thyroid carcinoma is well-known for its low malignant potential with good prognostic outcome. It usually presents as a palpable thyroid mass but scarcely manifests as an isolated cervical lymphadenopathy. A 50-year-old man presented with a huge posterior cervical lymphadenopathy which was suspicious for metastatic papillary thyroid carcinoma on fine needle aspiration cytology. The thyroid gland was clinically not visible or palpable. After computed tomography of the neck, the patient was preceded with total thyroidectomy and right selective lymph node dissection. Histopathological assessment confirmed metastases in the lymph node and papillary thyroid carcinoma in the resected gland. The paper revisits this unfortunate case of huge metastatic posterior triangle papillary thyroid carcinoma, illustrating the surgical outlines and discussing literature review.

INTRODUCTION[|]Squamous cell carcinoma (SCC) is the most common lip carcinoma and nodal status is the single most important prognostic factor. Though surgery is the first choice of treatment in early-stage cases, elective neck dissection to treat an eventual occult metastasis is still a matter of discussion.[¤]METHODS[|]A total of 96 patients with lower lip SCC who were operated on in a single clinic between January 2005 and July 2017 were included in this study. Patients who did and did not undergo elective neck dissection after tumor resection according to risk and nodal status were studied in terms of age, gender, tumor size, and neck dissection type.[¤]RESULTS[|]Among 96 patients, 74 were classified as T1-2N0 according to the American Joint Committee on Cancer staging system, and 30 underwent elective neck dissection. Among these 30 patients, 6 were diagnosed with metastasis. A total of 51 of the 96 members of the study group underwent elective supraomohyoid neck dissection. In all, 23 patients were diagnosed with metastasis.[¤]DISCUSSION AND CONCLUSION[|]Lower lip SCC is a cancer with a relatively good prognosis, but regional lymph node metastasis decreases the survival rate substantially. In selected cases, staging the tumor via supraomohyoid neck dissection or sentinel lymph node biopsy is adequate to detect occult metastasis and prevent late lymph node metastasis.[¤]

Objective: Despite the known association of perioperative stroke with perioperative mortality, the prevalence of stroke following neck dissection in elderly patients remains unclear. This study compared the incidence of neck dissection-associated perioperative stroke in elderly and younger patients. Materials and Methods: Totally, 1057 patients receiving neck dissection for head and neck cancers between June 2012 and July 2016 were reviewed at a single center. The patients were divided into elderly (age ≥65 years, n = 177) and younger (age

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.

Carcinoma of the thyroid gland is one of the most commonly encountered endocrine malignancies. Papillary carcinoma is the most common histological type and its pattern of metastasis are usually lymphatic. Lymphatic metastasis to parapharyngeal space is rare and have been reported, so we report a case of 50-year-old male patient who had an occult papillary carcinoma of the thyroid presented as right lateral node of the neck and a nodal involvement of the right parapharyngeal space.

Introduction The efficacy of sentinel node biopsy in early stage oral cancer is well established. Its evolving role can be reinforced by further studies. Objective Analyzing the predictability of the levels of echelon nodes for various oral cavity tumor subsites on sentinel node biopsy. Methods A prospective study of 20 patients with stage I/II oral squamous cell carcinoma who underwent sentinel node biopsy-guided neck dissection between January 2017 and 2018 at our institute. The procedure included radiotracer injection, imaging (lymphoscintigraphy, single photon emission computed tomography-computed tomography), and gamma probe application. Sentinel node detection on imaging and gamma probe were compared. Results Out of 20 patients, 13 (65%) had carcinoma of the tongue, 6 (30%) had buccal mucosa carcinoma, and 1 (5%) had retromolar trigone carcinoma. The mean age of the patients was 52.3 years. A total of 13 (65%) patients were male, and 7 (35%) were female. The sentinel node identification rates with imaging and gamma probe were of 70% and 100% respectively. In tongue and retromolar trigone primaries, the most common first-echelon nodes in both modalities were levels IIA and IB respectively. For buccal mucosa primaries, first-echelon nodes were detected only with the gamma probe, which was level IB. On imaging, second-echelon nodes were detected only for tongue primaries, and had equivalent incidence of levels II, III, and IV. On the gamma probe, level IIA, followed by III, and IV for the tongue, and level IIA were the most common second-echelon nodes for the buccal mucosa. Third-echelon nodes were detected only with the gamma probe for tongue carcinoma at level IV. Conclusion The combined use of imaging and gamma probe provides the best results, with high identification rate and predictability of echelon levels.

The sixth most common cancer in the world is head and neck squamous cell carcinoma with an annual estimated incidence of around 275,000 for oral carcinoma. India has been cited frequently as the country with the highest incidence in the world with over 100,000 cases noted every year. Recurrence of oral squamous cell carcinoma are commonly seen as locoregional failure which is at the primary site or in the neck lymph nodes. Distant metastasis incidence is very uncommon and they are reported in lung, liver, and spinal cord. There are few reported cases of squamous cell carcinoma from oral cavity which has shown metastasis over the chest skin. This case report highlights a rare metastasis which, in spite of good locoregional control with surgery and adjunctive radiotherapy, resulted in a poor outcome.

Abstract Introduction Papillary thyroid carcinoma has a very high rate of lateral neck node metastases, and there is almost unanimity concerning the fact that some sort of formal neck dissection must be performed to address the clinical neck disease in these cases. Although there is an agreement that levels II to IV need to be cleared in these patients, the clearance of level V is debatable. Objectives We herein have tried to analyze various papers that have documented a structured approach to neck dissection in these patients. Moreover, we have also tried to consider this issue through various aspects, like spinal accessory nerve injury and the impact of neck recurrence on survival. Data Synthesis The PubMed, Medline, Google Scholar, Surveillance, Epidemiology, and End Results (SEER), and Ovid databases were searched for studies written in English that focused on lateral neck dissection (levels II–IV or II–V) for papillary thyroid carcinoma. Case reports with 10 patients or less were excluded. Conclusions The current evidence is equivocal whether to clear level V or not, and the studies published on this issue are very heterogeneous. Level II-IV versus level II-V selective neck dissections in node-positive papillary thyroid carcinoma patients is far from categorical, with pros and cons for both approaches. Hence, we feel that there is a need for more robust homogeneous data in order to provide an answer to this question.

ABSTRACT Objectives: The objectives of this study were to evaluate the following: 1) the accuracy of sentinel lymph node mapping (SLNM) in detecting metastasis in papillary thyroid carcinoma (PTC), and 2) if SLNM could modify the American Joint Committee on Cancer (AJCC) staging of previous cN0 PTC patients. Subjects and methods: Forty SLNM were performed prospectively in 38 consecutive cN0 PTC patients, with total thyroidectomy and elective compartment neck dissection (CND). The results of SLNM were compared with CND pathological findings to verify the accuracy of sentinel SLNM. Results: The mean patients’ follow-up was 36 months. A total of 133 SLN were found at levels VI, II, III and IV. The SLN was identified in 95% of the patients with one false negative, 95% sensitivity, a 94% negative predictive value and 97% accuracy. The SLNM upstaging from cN0 to pN+ was 49%, and to stages III and IVa, it was 21%. Conclusions: For this series of cN0 PTC patients: 1) SLNM accuracy was 97%, and 2) SLNM upstaging from cN0 to pN+ was 49%, whereas to stages III and IVa, it was 21%.

Abstract Introduction Oral cavity carcinoma is an aggressive tumor, with the tongue being one of the most common subsites of involvement. Surgery is a gold standard method of dealing with advanced-stage tumors. However, for early-stage carcinomas of the tongue, the management remains controversial. Several studies have indicated that early-stage cancers have a high chance of occult cervical node metastasis, which, if left untreated, can greatly affect the prognosis. Certain parameters can help identify patients with occult cervical node metastases, and can avoid unnecessary neck dissection in node negative patients. Tumor thickness is one such objective parameter. Objective To estimate the frequency of cervical lymph node metastasis in patients with early-stage, node-negative (N0) squamous cell carcinoma of the tongue. Methods In-patient hospital data was reviewed from January 2013 until March 2014, and 78 patients who underwent primary resection of the tumor and neck dissection for biopsy-proven, early stage squamous cell carcinoma of the tongue were included. Data such as tumor thickness, tumor differentiation and presence of occult nodal metastasis in the surgical specimen were gathered from the histopathology reports. The frequency of subclinical cervical lymph node metastasis in patients with early-stage squamous cell carcinoma of the tongue was estimated. Results A total of 69% of the patients with tumor thicknesses > 5 mm had tumor metastases in the neck nodes, while 100% of the patients with tumor thicknesses 5 mm is significantly associated with subclinical metastasis, and prophylactic neck dissection is warranted in such cases.

OBJECTIVES: The aim of this study is to investigate the role of neck dissection and wait-see policy for neck treatment on prognosis of patients with early stage lip cancer.METHODS: The study included 20 patients ( 5 females, 15 males; mean age 62.64 years; range 38 to 80 years) who underwent surgery for primary site and neck between March 2007 and April 2015 because of T1-2N0 lower lip cancer. Data were reviewed retrospectively on clinical features, localization of the lesion, regional lymph node status, tumor staging, results of surgical treatment and pathological examination. Tumor was excised with 1 cm surgical margin in all cases. The tissue defect was reconstructed by primary closure or varied reconstrction techniqcs. All T2N0 stage patients underwent neck dissection. If the tumor was located in the middle of the lip, bilateral neck dissection, otherwise unilateral neck dissection was performed. RESULTS: Histopathologic diagnosis was squamous cell carcinoma in all cases. The mean follow-up period was 45.82 months. There were 15 patients with clinically diagnosed T1N0 tumors and 5 patients with clinically diagnosed T2N0 tumors. For T1N0 tumors, 3 suprahyoid, 2 bilateral supraomohyoid neck dissections were performed. Supraomohyoid neck dissection was performed in bilaterally in 3 T2N0 tumors, and suprahyoid neck dissection was performed in remaing 2 tumors. CONCLUSION: Four years survival rates without illness were significantly higher in cases with early stage lip cancer. Our results present that neck dissection may not be necessary in patients with T1N0 lower lip cancers.

Cervical lymph node metastasis affects the prognosis and overall survival rate of and therapeutic planning for patients with head and neck squamous cell carcinomas (HNSCCs). However, advanced diagnostic modalities still lack accuracy in detecting occult neck metastasis. A sentinel lymph node biopsy is a minimally invasive auxiliary method for assessing the presence of occult metastatic disease in a patient with a clinically negative neck. This technique increases the specificity of neck dissection and thus reduces morbidity among oral cancer patients. The removal of sentinel nodes and dissection of the levels between the primary tumour and the sentinel node or the irradiation of target nodal basins is favoured as a selective treatment approach; this technique has the potential to become the new standard of care for patients with HNSCCs. This article presents an update on clinical applications and novel developments in this field.

Abstract Introduction Neck dissection (ND) technique preferences are not well reported. Objective The objective of this study is to educate practitioners and trainees about surgical technique commonality and variance used by head and neck oncologic surgeons when performing a ND. Methods Online survey of surgeon members of the American Head and Neck Society (AHNS). Survey investigated respondents' demographic information, degree of surgical experience, ND technique preferences. Results In our study, 283 out of 1,010 (28%) AHNS surgeon members with a mean age of 50.3 years (range 32–77 years) completed surveys from 41 states and 24 countries. We found that 205 (72.4%) had completed a fellowship in head and neck surgical oncology. Also, 225 (79.5%) respondents reported completing more than 25 NDs per year. ND technique commonalities (>66% respondents) included: preserving level 5 (unless with suspicious lymph nodes (LN)), only excising the portion of sternocleidomastoid muscle involved with tumor, resecting lymphatic tissue en bloc, preservation of cervical sensory rootlets, not performing submandibular gland (SMG) transfer, placing one drain for unilateral selective NDs, and performing a ND after parotidectomy and thyroidectomy and before transcervical approaches to upper aerodigestive tract primary site. Variability existed in the sequence of LN levels excised, instrument preferences, criteria for drain removal, the timing of a ND with transoral upper aerodigestive tract primary site resections, and submandibular gland preservation. Results showed that 122 (43.1%) surgeons reported that they preserve the submandibular gland during the level 1b portion of a ND. Conclusions The commonalities and variances reported for the ND technique may help put individual preferences into context.

Lower lip tumours are the most common among the oral cavity tumours. The purpose of this article is to analyse neck metastasis rates of early stage lower lip carcinomas and to evaluate possible related histological parameters with neck metastasis. The dissection types, preoperative detection of lymphadenopathy by palpation or computed tomography (CT), tumour sizes and tumour histological differentiation degrees of 37 patients were reviewed retrospectively. In addition, an experienced pathologist re-evaluated the specimens and examined tumour depth and muscle invasion. Types of neck dissection were bilateral supraomohyoid in 20, unilateral supraomohyoid in 8, bilateral suprahyoid in 5 and unilateral suprahyoid in 1 patients. All the carcinomas were squamous cell carcinoma (SCC) and T stages were T1 in 32 and T2 in 5. Preoperatively, 4 patients had palpable lymph nodes and 9 patients had lymph nodes in CT scan, but it was found out that none of these patients had histological positive lymph node metastasis. Histological node metastasis was found only in 1 patient who had stage T1 tumour, no palpable or detected lymph node, no muscular invasion and very limited tumour depth.Tumour size, differentiation degree, tumour depth and muscle invasion seems insensitive for predicting lymph node metastasis in early stage lower lip carcinomas. The necessity of neck dissection in early stage lower lip carcinomas should be reconsidered in large series of patients. [Med-Science 2016; 5(4.000): 933-6]

Introduction: Treatment of Oral Squamous Cell Carcinoma (SCC) requires a composite resection of the lesion and elective/ therapeutic neck dissection, whenever a surgical option is being considered as a form of treatment. During neck dissection, one of the critical structures to be preserved is the Spinal Accessory Nerve (SAN). In our experience of operating on N+ necks for selective neck dissections, we found the presence of a constant lymphnode at the level of hyoid bone/digastric muscle tendon lateral to the internal jugular vein (level IIa). Direct deeper dissection exactly beneath this node led to the identification of the SAN. Aim: The aim of the study was to ascertain level IIa lymph node as a landmark for identification of SAN, during neck dissection procedures. Materials and Methods: In this prospective study, 100 consecutive selective neck dissection procedures done for patients with radiological N+ necks with resectable Oral SCC were included. Results: In 96% of cases identification of SAN was done with the technique used alone. Conclusion: The purpose of this study was to establish this technique as a standard of care either alone or in adjunct with other established landmarks for identification of SAN, by trainees as has been a long established practice in our department. We even have a separate nomenclature for it, the ‘Trainee Node.