This study was performed to evaluate the incidence of metastasis at level I
in patients with squamous laryngeal cancer. One hundred consecutive patien
ts with squamous carcinoma of the larynx were submitted to surgical treatme
nt including radical neck dissection. The tumor stage was T3 or T4, and the
neck stage was N1-N2c. Lymph node metastases were pathologically confirmed
in 80 patients. Metastases were concentrated within level II in 59% of cas
es, level III in 17% of cases, level IV in 11 % of cases, and level V in 6%
of cases. Only 2 patients (2%) had detectable tumors in the lymph nodes of
the submandibular triangle (level IB). This study shows that patients with
laryngeal cancer rarely present metastases at the submandibular triangle,
even in advanced local disease with cervical metastasis staged as N1 to N2c
. Therefore, dissection of the submandibular triangle is indicated only in
the presence of clinical, radiographic, or cytologic evidence of metastatic
disease at level I.