Page 54 - Read Online
P. 54

It is very significant that most of cervical metastases   number of patients are necessary to confirm the results
            from SCC of the maxilla in the analysed series (71%)   obtained from this study.
            corresponded with a tumour size larger than 4 cm (T3
            and T4 tumours). This rate of cervical metastases from   Financial support and sponsorship
            big-sized tumours may suggest performing elective neck   Nil.
            dissection only in patients with advanced disease. This
            finding has been observed by an American multicenter   Conflicts of interest
                                [16]
            study by Montes et al.  about maxillary SCC, which   There are no conflicts of interest.
            reported a high percentage of cervical metastases in
                                        [21]
            T3 and T4 tumours. Meng et al.,  in their series of 78   REFERENCES
            patients with SCC of the maxilla, reported that rates
            for positive nodal metastases from T1 and T2 tumours   1.   Shah JP, Candela FC, Poddar AK. The patterns of cervical lymph node
            were lower than 15%, whereas those for T3 and T4      metastases from squamous carcinoma of the oral cavity. Cancer
            tumours were higher than 40%. Zhang et al.,  in a series   1990;66:109-13.
                                                [37]
            of 100 patients, observed a 79% of cervical metastases in   2.   Woolgar JA. Histological distribution of cervical lymph node
                                                                  metastases from intraoral/oropharyngeal squamous cellcarcinomas.
            patients with T3/T4 SCC of the upper maxilla. Brown et al.    Br J Oral Maxillofac Surg 1999;37:175-80.
                                                         [10]
            reported an 81% of cervical metastases in T3/T4 tumours   3.   González-García R, Naval-Gías L, Román-Romero L, Sastre-Pérez J,
                                                [40]
            in a series of 43 patients, while Berger et al.  in a series   Rodríguez-Campo FJ. Local recurrences and second primary tumors
            of 171 patients, observed a 78% of cervical metastases   from squamous cell carcinoma of the oral cavity: a retrospective
                                                                  analytic study of 500 patients. Head Neck 2009;31:1168-80.
            in patients with T3/T4 stage. Even others authors have   4.   Kowalski LP, Bagietto R, Lara JR, Santos RL, Tagawa EK, Santos IR.
            reported that all the patients (100%) with advanced-stage   Factors influencing contralateral lymph node metastasis from oral
            (T3/T4) developed cervical metastases in some point   carcinoma. Head Neck 1999;21:104-10.
            during the study. [13,30,33,42]                   5.   Weiss MH, Harrison LB, Isaacs RS. Use of decision analysis in planning
                                                                  a management strategy for the stage N0 neck. Arch Otolaryngol Head
                                                                  Neck Surg 1994;120:699-702.
            Within our meta-analysis, in 24 out of 28 articles,   6.   Capote A, Escorial V, Muñoz-Guerra MF, Rodriguez-Campo FJ,
            metastases  in  patients  with  T3/T4  tumours  were   Gamallo C, Naval L. Elective neck dissection in early-stage oral
            analysed, founding a total of 71% of cervical metastases.   squamous cell carcinoma-does it influence recurrence and survival?
            These data could demonstrate a significant connection   7.   Head Neck 2007;29:3-11.
                                                                  Hiratsuka H, Miyakawa A, Nakamori K, Kido Y, Sunakawa H, Kohama G.
            between T-stage and metastatic cervical status, and may   Multivariate analysis of occult lymph node metastasis as a prognostic
            suggest that patients with advanced-stage (T3/4) disease   indicator for patients with squamous cell carcinoma of the oral cavity.
            face a significantly higher risk of metastases.       Cancer 1997;80:351-6.
                                                              8.   Yuen AP, Ho CM, Chow TL, Tang LC, Cheung WY, Ng RW, Wei WI,
                                                                  Kong CK, Book KS, Yuen WC, Lam AK, Yuen NW, Trendell-Smith
            It is a fact that most clinicians do not routinely perform   NJ, Chan YW, Wong BY, Li GK, Ho AC, Ho WK, Wong SY, Yao TJ.
            elective neck dissection when the neck is clinically or   Prospective randomized study of selective neck dissection versus
            radiographically negative. However, the results from our   observation for N0 neck of early tongue carcinoma. Head Neck
            systematic review suggest that elective neck dissection   9.   2009;31:765-72.
                                                                  Montes DM, Schmidt BL. Oral maxillary squamous cellcarcinoma:
            should be performed in patients with locally advanced   management of the clinically negative neck. J Oral Maxillofac Surg
            SCCs of the hard palate and maxillary alveolus, despite   2008;66:762-6.
            the fact that SCC of these sites has traditionally been   10.  Brown JS, Bekiroglu F, Shaw RJ, Woolgar JA, Rogers SN. Management
            believe to have a low rate of occult metastases.      of the neck and regional recurrence in squamous cell carcinoma of
                                                                  the maxillary alveolus and hard palate compared with other sites in
                                                                  the oral cavity. Head Neck 2013;35:265-9.
            In spite of the results observed from this meta-analysis,   11.  Simental AA,  Johnson  JT,  Myers  EN.  Cervical  metastasis  from
            we believe that it is important to highlight that most   squamous cell carcinoma of the maxillary alveolus and hard palate.
            of the analysed studies are retrospective, with their   Laryngoscope 2006;116:1682-4.
            intrinsic limitations. Furthermore, several papers are   12.  Kruse AL, Grätz KW. Cervical metastases of squamous cellcarcinoma
                                                                  of the maxilla: a retrospective study of 9 years. Head Neck Oncol
            limited by the small number of patients enrolled in the   2009;20:1-28.
            study. Therefore, prospective studies with larger series   13.  Mourouzis C, Pratt C, Brennan PA. Squamous cell carcinoma of the
            are necessary.                                        maxillary gingiva, alveolus, and hard palate: is there a need for elective
                                                                  neck dissection? Br J Oral Maxillofac Surg 2010;48:345-8.
                                                              14.  Ogura I, Kurabayashi T, Sasaki T, Amagasa T, Okada N, Kaneda T.
            In conclusion, this systematic review shows the fact   Maxillary bone invasion by gingival carcinoma as an indicator of
            that the rate of metastases in patients with SCC of the   cervical metastasis. Dentomaxillofac Radiol 2003;32:291-4.
            upper maxilla is high and comparable with metastases   15.  Morris LG, Patel SG, Shah JP, Ganly I. High rates of regional failure in
            from other oral cavity cancers. Thus, the authors believe   squamous cell carcinoma of the hard palate and maxillary alveolus.
                                                                  Head Neck 2011;33:824-30.
            in the need for a change in the management of the N0   16.  Montes DM, Carlson ER, Fernandes R, Ghali GE, Lubek J, Ord R,
            neck in SCC arising in the maxillary alveolus and hard   Bell B, Dierks E, Schmidt BL. Oral maxillary squamous carcinoma: an
            palate. Elective neck dissection should be performed in   indication for neck dissection in the clinically negative neck. Head
                                                                  Neck 2011;33:1581-5.
            patients with T3/T4 tumours with clinic or radiographic   17.  Kermer C, Poeschl PW, Wutzl A, Schopper C, Clemens K, Poeschl
            negative necks (N0c). Prospective studies with a large   E. Surgical treatment of squamous cell carcinoma of the maxilla and
            Plast Aesthet Res || Volume 3 || June 24, 2016                                                179
   49   50   51   52   53   54   55   56   57   58   59