Elsheikh Mohamed N, Rinaldo Alessandra, Ferlito Alfio, Fagan Johannes J, Suárez Carlos, Lowry John, Paleri Vinidh, Khafif Avi, Olofsson Jan
Department of Otolaryngology - Head and Neck Surgery, Tanta University, Tanta, Egypt.
Oral Oncol. 2008 Mar;44(3):216-9. doi: 10.1016/j.oraloncology.2007.06.006. Epub 2007 Sep 7.
Spinal accessory nerve (SAN) dysfunction and related shoulder disability are common consequences of supraomohyoid neck dissection (SOHND). Nerve dysfunction is usually attributed to excessive nerve traction or devascularization during clearance of the lymph nodes posterior and superior to the SAN (sublevel IIB). The need for routine dissection of this sublevel with elective neck dissection has recently been questioned. This review article discusses whether preserving sublevel IIB lymph nodes is justified in elective SOHND for patients with squamous cell carcinoma (SCC) of the oral cavity. A review of the literature was conducted on studies of sublevel IIB dissection in elective SOHND for SCC of the oral cavity. Only two studies have prospectively investigated the incidence of lymph node metastasis in patients with clinically N0 SCC of the oral cavity. Data from these two prospective pathologic and molecular analyses of neck dissection specimens, including 122 patients with N0 oral cancer, revealed 7.3% with positive neck nodes at sublevel IIB for oral cancer in general, and 12% for tongue cancer in particular. When considering the merits of preservation of sublevel IIB, the benefit of preservation of SAN function has to be weighed against potentially reduced oncologic control.
副神经（SAN）功能障碍及相关肩部功能障碍是肩胛舌骨肌上颈清扫术（SOHND）常见的后果。神经功能障碍通常归因于在清扫副神经后方和上方（IIB亚区）的淋巴结时神经受到过度牵拉或血运障碍。近期，对于选择性颈清扫术中常规清扫该亚区的必要性提出了质疑。这篇综述文章探讨了在口腔鳞状细胞癌（SCC）患者的选择性SOHND中保留IIB亚区淋巴结是否合理。对关于口腔SCC选择性SOHND中IIB亚区清扫的研究进行了文献综述。仅有两项研究前瞻性地调查了临床N0期口腔SCC患者的淋巴结转移发生率。这两项对颈清扫标本进行的前瞻性病理和分子分析的数据，包括122例N0期口腔癌患者，显示总体上IIB亚区口腔癌阳性颈淋巴结的发生率为7.3%，舌癌为12%。在考虑保留IIB亚区的益处时，必须权衡保留副神经功能的益处与潜在降低的肿瘤学控制效果。
