Page 53 - Read Online

on cervical metastases from SCC of the maxilla.
Nevertheless, cervical metastases from SCC of tongue
or floor of mouth have been well studied, both sites
presenting a high incidence, considering elective neck
dissection necessary in patients.

Elective neck dissection is generally performed in
patients with SCC of the oral cavity when there is a
risk of occult metastases higher than 15%. It is made at
the time of surgery of the primary tumour, since most
cancers of the oral cavity are treated surgically. [1-5] The
risk of cervical metastases of maxillary gingival and
hard palate SCC is considered lower than metastases of
SCC in other primary sites, and management of clinical
NO (cN0) patients is to “watch and wait”. The National
Comprehensive Cancer Network proposed guidelines
for treatment strategies for head and neck cancer,
suggesting selective neck dissection for cN0 patients
with SCC of the tongue, floor of the mouth, mandibular
[44]
gingiva, and buccal mucosa. However, there is still no
specific strategy for cN0 cases of maxillary SCC.

Recently, several studies reported that cervical
metastases of maxillary SCC are much higher than
expected and comparable to that of other primary oral
Figure 2: (A) Intraoperative photograph of a patient with T4 squamous [9]
cell carcinoma of the maxillary gingiva and bone invasion; (B) maxillary sites. Montes and Schmidt reported a 42.9% rate of
tumour was resected with wide surgical margins regional nodal disease in a series of 14 patients with SCC
[10]
of the maxilla; Brown et al. reported a rate of 37.2%
[11]
in a series of 43 patients; Simental et al. in a series of
26 patients with SCC of the maxillary alveolus and hard
palate found cervical metastases in 34.6%, similar to that
[12]
observed by Kruse and Grätz (33.6%) in a series of 30
[13]
patients. Mourouzis et al. reported a 23.5% incidence
of cervical metastases at presentation with maxillary SCC
in a series of 17 patients. These reported incidences of
cervical metastases are comparable to those observed for
[14]
SCC of tongue or floor of mouth. Ogura et al. reported
a 28.5% incidence of cervical disease at presentation.
[40]
Recently, Berger et al. reported an overall rate of 44%
of cervical metastases in a series of 171 patients. In
our series, we founded that 9 of the 20 (45%) patients
with SCC involving the palate or the maxillary alveolus
[Figures 1 and 2] developed cervical metastases [Figure 3]
during disease. [42]

In the 28 articles included in this systematic review, the
initial nodal disease was 16% and cervical metastases
rate ranged from 11% to 67% with an overall metastases
rate of 33% in a total of 2,641 patients, which was
similar to the cervical metastases from SCC of other oral
Figure 3: Computed tomography of the neck showing a cervical sites, such as the tongue or floor of the mouth.
metastasis (arrow) of maxillary squamous cell carcinoma
According to the tumour node metastasis classification
metastases from maxillary SCC carcinoma were T3/T4 system, T represents tumour size, depth of invasion, and
stage [Table 1].
relation with the surrounding tissue. The association
between tumour site, size and grading and the risk
DISCUSSION
of lymphatic metastases is well known for SCC of oral
In the last century, few studies have been focused cavity and is not different for SCC of the maxilla. [44]
178 Plast Aesthet Res || Volume 3 || June 24, 2016