title: IIb or not IIb: oncologic role of submuscular recess inclusion in selective neck dissections.
abstract: OBJECTIVE
  Selective neck dissections (SNDs) can yield outcomes that are oncologically similar to radical dissections but with less morbidity. The rate of metastasis to level IIb is not clear, and its dissection involves cranial nerve XI traction and devascularization, causing much morbidity. Our study examined the prevalence and predictors of cancer within the submuscular recess (SMR).
  
  
  METHODS
  All SNDs performed by the authors were prospectively included from July 1, 2002, to March 31, 2006. Level IIb was sent as a distinct specimen.
  
  
  RESULTS
  One hundred fifty-two dissections were performed. Only 12 (7.9%) were node positive in IIb. The SMR contained diseased nodes in 12.2% of N+ necks and 3.0% of N0 necks (p = .04); 23.1% (3 of 13) of laryngeal (1 of 8) and hypopharyngeal (2 of 5) tumours were node positive in IIb versus 6.4% in the oral cavity (p = .07) and 5.3% in oropharyngeal lesions.
  
  
  CONCLUSIONS
  This is one of the largest prospective studies examining the role of level IIb dissection. It suggests that level IIb dissection might be unnecessary, especially in an N0 neck.
authors.affiliation: Department of Surgery, Division of Otolaryngology, Dalhousie University, Halifax, Nova Scotia. bjahoyt@dal.ca
authors.forename: Benjamin J A
authors.initials: BJ
authors.lastname: Hoyt
authors.forename: Rachel
authors.initials: R
authors.lastname: Smith
authors.forename: Anita
authors.initials: A
authors.lastname: Smith
authors.forename: Jonathan
authors.initials: J
authors.lastname: Trites
authors.forename: S Mark
authors.initials: SM
authors.lastname: Taylor
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods*; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D019534:Shoulder Impingement Syndrome / Q000209:etiology / Q000517:prevention & control*; D016019:Survival Analysis; D016896:Treatment Outcome; D019564:Unnecessary Procedures