Metastasis to submandibular glands in oral cavity cancers: Can we preserve the gland safely?
OBJECTIVE
To analyze submandibular gland (SMG) involvement in cases of oral cavity cancers and decide whether to remove submandibular glands while performing neck dissections for oral cavity cancers to decrease the incidence of xerostomia, a common issue post-operatively.


METHODS
Retrospective analysis of 157 neck dissections out of 204 neck dissections performed for oral cavity carcinomas in the Department of Otolaryngology and Head and Neck Surgery from 2008 to 2013 was done. SMG was bilaterally removed in 6 dissections, hence a total of 163 glands were analyzed. Those involved by tumor in histopathology were further studied for the pattern of involvement.


RESULTS
3.68% (6/163) glands showed involvement by the tumor. 9.20% (15/163) showed chronic sialo-adenitic changes. Four of the six involved glands showed direct contiguous spread from primary lesion, one showed extra-capsular spread from level IB lymph nodes and evidence of both modes of spread was seen in one. Evidence of metastasis was not seen in any of the glands (0%). Literature review showed a metastasis rate of 0.096% (2/2074).


CONCLUSIONS
Metastatic involvement of submandibular gland is extremely rare. Submandibular gland preservation, in the absence of evidence of gross contiguous involvement, does not affect survival. Hence, SMG can be safely spared during neck dissections for oral cavity squamous cell cancers except in certain situations such as close proximity of the primary lesion to gland, presence of intra-capsular lymph nodes in radiology, gross intraoperative evidence of invasion of the SMG and in salvage surgeries performed in post-irradiated and recurrent cases.
Department of ENT and Head and Neck Surgery, PGIMER, Chandigarh, India.
Naresh K
NK
Panda
Department of ENT and Head and Neck Surgery, PGIMER, Chandigarh, India.
Sourabha K
SK
Patro
Department of ENT and Head and Neck Surgery, PGIMER, Chandigarh, India.
Jaimanti
J
Bakshi
Department of ENT and Head and Neck Surgery, PGIMER, Chandigarh, India. Electronic address: roshanverma@hotmail.com.
Roshan K
RK
Verma
Department of Histopathology, PGIMER, Chandigarh, India.
Ashim
A
Das
Department of Histopathology, PGIMER, Chandigarh, India.
Debajyoti
D
Chatterjee
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000556:secondary / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D037981:Neck Dissection / Q000379:methods*; D059351:Organ Sparing Treatments; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D013363:Submandibular Gland / Q000473:pathology*; D013365:Submandibular Gland Neoplasms / Q000556:secondary*; D014987:Xerostomia / Q000517:prevention & control*; D055815:Young Adult
Justified; Neck dissection; Oral carcinoma; SMG excision