To determine the optimal type of neck dissection for N0 cases of squamous cell carcinoma of the tongue, the pattern of occult metastases was evaluated.
Between 1974 and 1997, 35 N0 cases without local recurrence were histologically confirmed to have cervical lymph node metastasis. Of the 35 patients, 4 underwent elective neck dissection (END) and the others underwent therapeutic neck dissection (TND). Recurrence in the dissected area developed in 6 patients who had received TND. In the END group, the number of positive nodes was 1 or 2, and neck involvement was located at levels I to III. In the TND group, the number of positive nodes was 1 or 2 in 28 patients and 3 or more in 3 patients. Level I to III nodes were involved in 26 patients, level IV in 2, and level V in 3.
Supraomohyoid neck dissection can be considered a standard elective treatment for squamous cell carcinoma of the tongue. However, in patients who subsequently developed cervical metastasis, either radical neck dissection or modified radical neck dissection should be performed.