title: An update on the latest evidence for managing the clinically negative neck (cN0) in oral squamous cell carcinoma.
abstract: The single most important prognostic indicator for survival in oral squamous cell carcinoma (OSCC) is the presence of lymph node metastases in the neck. While the treatment of the clinically node positive (cN+) neck is well established, the management of the clinically negative neck (cN0) is controversial. Various strategies have been advocated including close observation including regular ultrasound imaging, elective neck dissection and sentinel lymph node biopsy. Neck dissection surgery is not without potential morbidity with shoulder dysfunction being the main complication. A number of factors are associated with increased risk of neck node metastasis including primary tumour thickness and peri-neural invasion. A recent prospective randomised trial has found survival benefit following neck dissection even in patients with a cN0 neck at presentation. We discuss the latest evidence for managing the cN0 in OSCC and include our own experience on the role of neck dissection in certain cases.
authors.affiliation: Department Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Brennan
authors.affiliation: Department Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: S
authors.initials: S
authors.lastname: Subramaniam
authors.affiliation: Department Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: C
authors.initials: C
authors.lastname: Tsioryannis
authors.affiliation: Department of Gastroenterology, Torbay Hospital, Torquay, UK.
authors.forename: B
authors.initials: B
authors.lastname: Green
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D009062:Mouth Neoplasms / Q000473:pathology*; D037981:Neck Dissection; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D057832:Watchful Waiting
keywords: clinically negative neck; imaging; neck dissection; oral squamous cell carcinoma; sentinel lymph node biopsy