SUPRASPINAL ACCESSORY LYMPH-NODE METASTASES IN SUPRAOMOHYOID NECK DISSECTION

BACKGROUND: Some patients undergoing surgical resection of primary squ amous cell carcinoma of the oral cavity and oropharynx also undergo su praomohyoid neck dissection for staging of the negative (N-o) neck. Di ssection of the supraspinal accessory lymph node pad requires signific ant traction of the spinal accessory nerve. There are currently no dat a to indicate the incidence of metastases to this site and thus the ne cessity of performing dissection of these nodes.METHODS: A prospective analysis of a consecutive series of 44 patients with newly diagnosed squamous carcinoma of the oral cavity or oropharynx undergoing surgica l management of the primary lesion with staging neck dissection was pe rformed. Patients underwent unilateral (41) or bilateral (3) supraomoh yoid neck dissection with separate submission of the supraspinal acces sory lymph node pad for pathologic evaluation to determine the inciden ce of nodal metastases. RESULTS: A total of 15 patients (32%) had micr oscopic metastatic squamous cell carcinoma involving the supraomohyoid neck dissection specimen. Only 1 patient had a metastatic deposit inv olving the supraspinal accessory lymph node pad. This patient also had metastases in additional lymph nodes at level II. There was an equal incidence of metastases for all patients when stratifying by T stage. CONCLUSION: This preliminary report reveals a small incidence of supra spinal accessory lymph node metastases in patients with T + NO squamou s cell carcinoma of the oral cavity and oropharynx. We continue to acc rue patients to determine if the incidence of supraspinal accessory ly mph node metastases varies with an increased number of patients. (C) 1 996 by Excerpta Medica, Inc.