title: Metastatic neck disease beyond the limits of a neck dissection: attention to the 'para-hyoid' area in T1/2 oral tongue cancer.
abstract: OBJECTIVE
  We evaluated patients with small oral tongue cancer suffering from recurrence, which develops in the intervening area between the primary site and the neck. Lesions in the area around the cornu of the hyoid bone ('para-hyoid' area) often involve the hypoglossal nerve and the root of the lingual artery, resulting in treatment failure and death.
  
  
  METHODS
  A 10-year retrospective chart review was conducted of 248 oral tongue cancer patients with small primary tumors (T1/2). No patients who underwent postoperative radiotherapy (PORT) were included.
  
  
  RESULTS
  After excluding those who had local failure or developed new primary lesions, 6.3% of the patients were noted to have a para-hyoid lesion. A similar incidence was observed between the patients with and without previous neck dissection, 6.9% and 5.7%, respectively. All but one patient died due to uncontrolled neck disease.
  
  
  CONCLUSIONS
  Recurrent para-hyoid lesions could occur, irrespective of a previous neck dissection. In other words, the para-hyoid area is beyond the limits of a neck dissection. Once a para-hyoid lesion becomes clinically evident, it seems difficult to salvage. Therefore, a careful inspection of the area should be included intraoperatively in any type of neck dissection (i.e. elective or therapeutic) for patients with oral tongue cancer. This may be the key to improving the regional control rate of patients with small oral tongue cancer. We believe that some patients will benefit from more aggressive treatment of the neck, although PORT seems unnecessary for the majority of the patients with limited neck disease.
authors.affiliation: Head and Neck Surgery Division, National Cancer Center Hospital, Tokyo, Japan. andom-tky@umin.ac.jp
authors.forename: Mizuo
authors.initials: M
authors.lastname: Ando
authors.forename: Masao
authors.initials: M
authors.lastname: Asai
authors.forename: Takahiro
authors.initials: T
authors.lastname: Asakage
authors.forename: Waichiro
authors.initials: W
authors.lastname: Oyama
authors.forename: Masahisa
authors.initials: M
authors.lastname: Saikawa
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Masakazu
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Toru
authors.initials: T
authors.lastname: Ugumori
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daiko
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Hayashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000556:secondary* / Q000601:surgery*; D005260:Female; D005927:Glossectomy; D006801:Humans; D006928:Hyoid Bone; D015994:Incidence; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000706:statistics & numerical data*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D014062:Tongue Neoplasms / Q000601:surgery*