Montes David M, Schmidt Brian L
Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA 94143, USA.
J Oral Maxillofac Surg. 2008 Apr;66(4):762-6. doi: 10.1016/j.joms.2007.12.017.
Squamous cell carcinomas of the hard palate, maxillary gingiva, and maxillary alveolus occur at relatively low rates compared with squamous cell carcinomas in other oral sites. There is little within the surgical literature to guide treatment for maxillary squamous cell carcinoma. To date, only 1 other group has addressed neck management in the oral maxillary squamous cell carcinoma patient presenting with a clinically negative neck. Adequate characterization of maxillary gingival carcinoma behavior with respect to regional cervical metastasis is wanting.
We present a retrospective review of our own clinical experience as well as a review of the existing literature.
In our University of California San Francisco patient group, cervical disease was detected in 20% of those individuals with maxillary squamous cell carcinoma presenting for initial consultation. After ablative surgery, those individuals who presented with clinically negative necks had a 21.4% rate of regional node metastasis. Ultimately, 50% of our patients with squamous cell carcinomas of the palate, maxillary gingiva, and maxillary alveolus developed regional or metastatic distant disease; 42.9% of the patients manifested disease to the cervical lymph nodes alone.
The cases of oral maxillary squamous cell carcinomas reviewed herein exhibit aggressive regional metastatic behavior comparable to that of such carcinomas of the tongue, floor of the mouth, and mandibular gingiva. Based on the findings presented herein, we recommend selective neck dissection in the setting of a clinically negative neck as a primary management strategy for patients with oral maxillary squamous cell carcinomas involving the palate, maxillary gingiva, and maxillary alveolus.
与口腔其他部位的鳞状细胞癌相比，硬腭、上颌牙龈和上颌牙槽嵴的鳞状细胞癌发病率相对较低。外科文献中几乎没有指导上颌鳞状细胞癌治疗的内容。迄今为止，仅有另一组研究探讨了口腔上颌鳞状细胞癌患者颈部临床阴性时的颈部处理。目前尚缺乏对上颌牙龈癌区域颈淋巴结转移行为的充分描述。
我们回顾了自身的临床经验并对现有文献进行了综述。
在我们加利福尼亚大学旧金山分校的患者组中，初诊的上颌鳞状细胞癌患者中有20%检测到颈部病变。在进行根治性手术后，那些颈部临床阴性的患者区域淋巴结转移率为21.4%。最终，我们患有硬腭、上颌牙龈和上颌牙槽嵴鳞状细胞癌的患者中有50%发生了区域或远处转移；42.9%的患者仅出现颈部淋巴结病变。
本文所回顾的口腔上颌鳞状细胞癌病例表现出与舌、口底和下颌牙龈的此类癌相似的侵袭性区域转移行为。基于本文的研究结果，我们建议对于涉及硬腭、上颌牙龈和上颌牙槽嵴的口腔上颌鳞状细胞癌患者，在颈部临床阴性的情况下，将选择性颈清扫作为主要治疗策略。
