BACKGROUND: The indication of selective neck dissection with removal of lymph nodes at risk only, can be an adequate therapeutic approach for squamous cell carcinoma of the mouth. Our objective is to assess the level of neck node metastases in patients with squamous cell carcinoma of the lower part of mouth treated in a single institution. METHODS: 416 patients with lip, oral tongue, floor of mouth, lower gingiva, buccal mucosa and retromolar trigone cancer underwent neck dissection from 1977 to 2001 and the level of metastases were assessed. RESULTS: Level I was involved in 107/519 (20%) neck dissection, level II in 147/519 (28%), level III in 75/519 (14%), level IV in 32/419 (7%) and level V in 22/419 (5%). The false-negative rate was 36% and the false-positive was 30%. Patients with level I and/or II, III, IV or V had an average of 2.2, 4.8, 6.5 and 7.5 positive lymph nodes respectively (p < 0.0001). Metastases at level IIb were diagnosed in 21 (5%) patients, 11 (52%) of them had metastases at level V (p < 0.0001). CONCLUSIONS: Neck dissection, including levels I to IV, remove almost all metastatic lymph nodes from squamous cell carcinoma of the mouth and can be an adequate therapeutic approach even when positive lymph nodes are detected. Metastasis at level IIb increased the risk of disease in level V.
Lymphatic metastasis; Neck dissection; Carcinoma; Squamous cell; Mouth neoplasms
