LYMPHATICS OF THE SUBMANDIBULAR SPACE - AN ANATOMIC, CLINICAL, AND PATHOLOGICAL-STUDY WITH APPLICATIONS TO FLOOR-OF-MOUTH CARCINOMA

The detection and management of submandibular metastases are fundament al to the treatment of oral carcinoma. Detailed investigation of subma ndibular lymphatic anatomy and subsite predilection for metastases, as well as a comprehensive method for submandibular space dissection, ha ve been lacking, This thesis explores submandibular lymphatic anatomy through a review of the literature and cadaver dissections. A standard ized lymph node nomenclature and submandibular dissection technique ar e proposed. Also presented is a report on 41 consecutive patients with floor-of-mouth squamous cell carcinoma who were prospectively evaluat ed and treated. Pretreatment clinical and computed tomography (CT) exa minations revealed the detection of submandibular metastases to be mor e difficult than for the remainder of the neck and not improved by the routine use of CT scanning, Management of the neck was either with su rgery, which included complete bilateral level I dissections, or at le ast 2-year follow-up when left untreated. Overall, 39% of patients man ifested submandibular disease. The majority of submandibular metastase s in this study measured 1 cm or less and most commonly involved the p erivascular (primarily prevascular) nodes followed by the preglandular and, previously ill-defined, deep nodes. These findings are discussed with regard to the rationale for currently used neck dissections.