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Damon A. Silverman, MD; Michel El-Hajj, MD; Scott Strome, MD; Ramon M. Esclamado, MD

Arch Otolaryngol Head Neck Surg. 2003;129:724-728.

Objectives  To determine the prevalence of nodal metastases in the submuscular recess (SMR) in patients undergoing selective neck dissection (SND) and to identify potential risk factors for the presence of metastatic disease in the SMR.

Design  Prospective cohort study.

Setting  Academic tertiary care referral center.

Patients  Consecutive patients undergoing SND for squamous cell carcinoma of the head and neck between January 5, 1998, and November 23, 2001, were prospectively analyzed. Patients with a history of neck dissection or whose pathology reports did not clearly distinguish the SMR from other nodal levels were excluded from the study.

Interventions  Patients underwent SND based on the primary tumor site and well established regional lymphatic drainage patterns.

Main Outcome Measure  Presence of histopathologically proven nodal disease in the SMR.

Results  Seventy-four patients underwent 90 SNDs, 16 of which were bilateral. The prevalence of metastases in the SMR was 1.6% (1/63) in clinically N0 necks and 11.1% (3/27) in clinically node-positive necks, with an overall incidence of 4.4% (4/90). There was a statistically significant association between SMR metastases and advanced pathologic N stage (P = .003), particularly with positive nodal disease in level IIa (P = .001). Extracapsular tumor spread was also shown to have a statistically significant association with metastases in the SMR (P = .01). No significant associations were observed between SMR metastases and primary tumor site (P = .06), clinical N stage (P = .09), a history of primary tumor recurrence (P = .52), or previous radiation therapy (P = .68).

Conclusion  The results of the present study suggest that nodal metastases in the SMR are rare in head and neck cancer patients undergoing SND.

From the Departments of Otolaryngology and Communicative Disorders, The Cleveland Clinic Foundation, Cleveland, Ohio (Drs Silverman and Esclamado), and Otolaryngology–Head and Neck Surgery, American University of Beirut, Beirut, Lebanon (Dr El-Hajj), and Mayo Clinic Foundation, Rochester, Minn (Dr Strome). The authors have no relevant financial interest in this article.