Prospective analysis of 231 elective neck dissections in oral squamous cell carcinoma with node negative neck-To decide the extent of neck dissection.

Objective: To evaluate the incidence of level IIB and IV lymph node metastases in patients of oral carcinoma with N0 necks. This study will help to decide the extent and need of routine comprehensive removal of these specific lymph node groups in selective neck dissection.

Methods: Prospective analytical study of 231 patients of oral carcinoma with N0 necks undergoing neck dissections were prospectively analyzed. The incidence of metastases at level IIB and IV were then observed.

Results: 71 (30.73%) out of 231 cases had microscopic metastatic lymphadenopathy. Lymph node metastases from oral cancers were seen predominantly at levels IB and IIA. Metastases at levels IIB and IV were very rare (0.86% and 0%, respectively). Metastases at level IIB was associated with metastases at the level IIA in both cases (100%) and with level IB in 1 case (50%). 27 (11.68%) out of 231 cases had positive IIA nodes and conversely, only 7.4% (2/27) of all level IIA metastases had positive nodes at level IIB.

Conclusions: Selective neck dissection from I-III may be adequate for majority of patients with oral cancers. Level IIB and IV need not be dissected in N0 patients.