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pN+ cases and total cases. For the patients without
neck dissection initially, those presenting with regional
metastases or recurrence during the follow-up period
would also be counted as pN+ cases. Several authors
reported high rate of total cervical metastases. In a
[40]
recent study, Berger et al. reported 44% of total cervical
[31]
metastases in a series of 171 patients. Yang et al.
observed a 37% of patients with cervical metastases during
the follow-up in a series of 62 patients. Eskander et al.
[32]
reported a total of 41% of cervical metastases in a well-
[9]
structured study of a 97 patients. Montes and Schmidt
reported a 42.9% rate of regional nodal disease in a series
of 14 patients. Brown et al. [10] reported a rate of 37.2% in
a series of 43 patients.

We can conclude from our meta-analysis about these 28
Figure 1: Intraoperative photograph of a patient with T4 squamous studies including 2,641 patients that the overall cervical
cell carcinoma of the hard palate with cervical metastases
metastases from SCC of the upper maxilla are 33%.
published in English. The PICO question was as follows: is
elective neck dissection necessary in oral squamous cell Initial nodal disease
carcinoma of the upper maxilla? Initial nodal disease was defined as the patients with
lymph neck node metastases from the physical and
The following exclusion criteria were applied: (1) case radiologic examination in the first examination and the
reports; (2) technical reports; (3) animal or in vitro studies; overall initial metastases rate was defined as the ratio
(4) review articles; (5) uncontrolled clinical studies; and (6) between the number of initial cN+ cases and total cases.
publications in which the same data were published by the This variable was analysed in 26 of the 28 articles [Table 1].
same group of researchers. The authors carefully assessed At the time of the primary diagnosis, in a series of 138
[29]
the eligibility of all studies retrieved from the databases. patients, Sagheb et al. observed 52 (38%) with cervical
From the included studies in the final analysis, the following metastases whereas 53 (38%) patients that had a T3 (n
data were extracted: authors, year of publication, country, = 6) or T4 (n = 47) tumour as well. Philip and James
[24]
study design, number of patients in the groups, initial nodal reported 33% (13) of patients with neck disease at
disease (%), and nodal disease in T3/T4 stage (%), overall presentation. Ogura et al. observed 28.5% of cervical
[14]
nodal disease incidence (%) and follow-up period. metastases at presentation in their series of 21 patients
with SCC of the upper maxilla. Dalal and McLennan
[30]
The selected articles were used to assess the rate of reported a 27% of cervical metastases at initial diagnosis.
cervical metastases in patients with squamous cell
carcinoma of the upper maxilla. From our meta-analysis among 26 studies including 2,396
patients with SCC of the upper maxilla, we can conclude
RESULTS that the overall initial cervical metastases rate is 16%.

The electronic search resulted in 502 entries. Four T3/T4 nodal rate
additional articles were identified by manual searching. We also analysed the incidence of cervical metastases
Of the 502 articles identified by electronic search, 305 of maxillary SCC in advanced-stage (T3/4) disease,
were excluded because they were being retrieved in more including 24 articles for this purpose. Interestingly, we
than one search. After the initial screening of titles and observed that the probability of lymph node metastases
abstracts, 169 articles were excluded because they were increased with the size of the tumour. Brown et al.
[10]
off topic. Thus, 28 articles were included in the review. reported an 81% of cervical metastases in T3/T4 tumours
[40]
in a series of 43 patients and Berger et al. observed a
Of the 28 articles, 26 were retrospective studies, 1 was 78% of cervical metastases in patients with T3/T4 stage
a cohort study, and 1 was a cross-sectional study. The in a series of 171 patients. Philip and James observed
[24]
studies included 2,641 cases in total [Table 1]. a 95% of cervical metastases in T3/T4 tumours. Even
[30]
[33]
authors such as Poeschl et al. or Dalal and McLennan
Rates of total cervical metastases reported that all the patients (100%) with advanced-stage
The rates of total cervical metastases were analysed in (T3/T4) developed cervical metastases.
28 articles [Table 1] in which metastases was confirmed
by pathological examination. The overall metastases From our meta-analysis these 24 studies including 2,551
rate was defined as the ratio between the number of patients, we observed that 71% of patients with cervical
Plast Aesthet Res || Volume 3 || June 24, 2016 177