title: Prevalence of nodal metastases in the submuscular recess (level IIb) during selective neck dissection.
abstract: OBJECTIVE
  To determine the prevalence of nodal metastases in the submuscular recess (SMR) in patients undergoing selective neck dissection (SND) and to identify potential risk factors for the presence of metastatic disease in the SMR.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Academic tertiary care referral center.
  
  
  METHODS
  Consecutive patients undergoing SND for squamous cell carcinoma of the head and neck between January 5, 1998, and November 23, 2001, were prospectively analyzed. Patients with a history of neck dissection or whose pathology reports did not clearly distinguish the SMR from other nodal levels were excluded from the study.
  
  
  METHODS
  Patients underwent SND based on the primary tumor site and well established regional lymphatic drainage patterns.Main Outcome Measure Presence of histopathologically proven nodal disease in the SMR.
  
  
  RESULTS
  Seventy-four patients underwent 90 SNDs, 16 of which were bilateral. The prevalence of metastases in the SMR was 1.6% (1/63) in clinically N0 necks and 11.1% (3/27) in clinically node-positive necks, with an overall incidence of 4.4% (4/90). There was a statistically significant association between SMR metastases and advanced pathologic N stage (P =.003), particularly with positive nodal disease in level IIa (P =.001). Extracapsular tumor spread was also shown to have a statistically significant association with metastases in the SMR (P =.01). No significant associations were observed between SMR metastases and primary tumor site (P =.06), clinical N stage (P =.09), a history of primary tumor recurrence (P =.52), or previous radiation therapy (P =.68).
  
  
  CONCLUSIONS
  The results of the present study suggest that nodal metastases in the SMR are rare in head and neck cancer patients undergoing SND.
authors.affiliation: Department of Otolaryngology and Communicative Disorders, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Damon A
authors.initials: DA
authors.lastname: Silverman
authors.forename: Michel
authors.initials: M
authors.lastname: El-Hajj
authors.forename: Scott
authors.initials: S
authors.lastname: Strome
authors.forename: Ramon M
authors.initials: RM
authors.lastname: Esclamado
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies