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The Management of Isolated Submandibular Lymph Node Metastases

Barry Strasnick, MD; Dennis M. Moore, MD; Elliot Abemayor, MD, PhD; Guy Juillard, MD; Yao S. Fu, MD

Arch Otolaryngol Head Neck Surg. 1990;116(2):173-176.

Abstract
• The management of patients with cervical metastases from unknown primary tumors presents a therapeutic challenge to both the head and neck surgeon and radiotherapist. If after careful search the primary tumor remains truly occult, traditional methods of radiotherapy encompassing fields from the base of skull to clavicles are often employed, with significant attendant morbidity. To determine if more limited therapy would be effective in cases of isolated regional lymph node metastases, the patterns of tumor spread to nodes in the submandibular region were studied. A retrospective analysis of 472 radical neck specimens obtained from 1975 to 1985 revealed 19 cases (4.0%) of cervical metastases limited to the submandibular triangle. Sources of these tumors included lip (3), buccal mucosa (4), nasal vestibule (1), floor of mouth (4), alveolar ridge (3), oral tongue (1), and unknown (3). It appears that solitary submandibular nodal metastases predominantly arise from sites in the oral or nasal cavity. This suggests that in patients with isolated submandibular lymph node metastases from occult primary sites, a more conservative therapeutic approach to potential primary sites is indicated after treatment of the metastatic focus.

(Arch Otolaryngol Head Neck Surg. 1990;116:173-176)

Author Affiliations
From the Division of Head and Neck Surgery and Jonsson Comprehensive Cancer Center (Drs Strasnick, Moore, and Abemayor), Departments of Radiation Oncology (Dr Juillard), and Pathology (Dr Fu), UCLA School of Medicine, Los Angeles, Calif.

Footnotes
Accepted for publication September 19, 1989.

Presented at the Southern California Chapter of the American College of Surgeons, Palm Springs, Calif, January 28, 1989.

Reprint requests to Division of Head and Neck Surgery, UCLA School of Medicine, CHS 62-132, Los Angeles, CA 90024 (Dr Abemayor).

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