title: Is neck dissection needed in squamous-cell carcinoma of the maxillary gingiva, alveolus, and hard palate? A multicentre Italian study of 65 cases and literature review.
abstract: The occurrence of occult cervical metastases due to squamous-cell carcinoma of the hard palate and maxillary alveolar ridge has not been studied systematically. We have observed that many patients return with a delayed cervical metastasis following resection of a primary cancer at these sites. Some of these patients have died as a result of a regional or distant metastasis, despite control of the primary cancer. The literature contains few recommendations to guide the treatment of maxillary squamous-cell carcinoma; prospective studies are difficult due to the rarity of such tumours. The aim of this study is to define the incidence of cervical metastasis and to investigate whether elective neck dissection is justified. We present a retrospective multicentre study of 65 patients with squamous-cell carcinomas of the maxillary alveolar ridge and hard palate and review of the existing literature. The overall incidence of cervical metastases was 21%. We evaluated the significance of primary-site tumours as indicator of regional disease. The maxillary squamous-cell carcinoma cases in our multicentre study and in the literature review exhibited aggressive regional metastatic behaviour, comparable with that of carcinomas of the tongue, mouth floor, and mandibular gingiva. Based on our findings, we recommend selective neck dissection in clinically negative necks as a primary management strategy for patients with maxillary squamous-cell carcinomas involving the palate, maxillary gingiva, or maxillary alveolus.
authors: Department of Maxillofacial Surgery, IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milano, Italy. giada.beltramini@hotmail.it
authors: Giada A
authors: GA
authors: Beltramini
authors: Olindo
authors: O
authors: Massarelli
authors: Marco
authors: M
authors: Demarchi
authors: Chiara
authors: C
authors: Copelli
authors: Andrea
authors: A
authors: Cassoni
authors: Valentino
authors: V
authors: Valentini
authors: Antonio
authors: A
authors: Tullio
authors: Aldo B
authors: AB
authors: Giannì
authors: Enrico
authors: E
authors: Sesenna
authors: Alessandro
authors: A
authors: Baj
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000539:Alveolar Process / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D005260:Female; D005881:Gingiva / Q000473:pathology; D005887:Gingival Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008441:Maxillary Neoplasms / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D037981:Neck Dissection; D010157:Palatal Neoplasms / Q000473:pathology / Q000601:surgery*; D021362:Palate, Hard / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome