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Selective Neck Dissection
The Challenge of Occult Metastases
Arch Otolaryngol Head Neck Surg. 1998;124:353.
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AT OUR institution, we have observed that patients with head and neck squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and supraglottic larynx have a 15% to 20% (or greater) probability of occult cervical node metastasis that is not detectable in the results of physical examination or computed tomography. The likelihood of occult spread to these nodes increases with increasing tumor size and thickness. Although the optimal treatment of these patients continues to be controversial and unresolved by a prospective, randomized, multisite, clinical trial, I believe that when the primary lesion is treated surgically, the patient should be encouraged strongly to accept the recommendation for a selective neck dissection.
In my opinion, although the treatment of these patients is still evolving, there is sufficient evidence to support the concept of therapeutic equivalence of selective neck dissection and modified radical neck dissection. It seems clear that radical neck dissection and . . . [Full Text of this Article]
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