Can Submandibular Gland be Preserved During Neck Disscetion in Oral Cavity Squamous Cell Carcinoma?

Submandibular gland is commonly removed as an integral part of level I neck dissection for oral cavity squamous cell carcinoma. However, it is unclear whether lymph nodes are present within the submandibular gland which may form the basis of lymphatic spread and gland removal. So, this study investigated the incidence of submandibular gland involvement in oral cavity squamous cell carcinoma to determine the possible feasibility of submandibular gland sparing neck dissection. The medical records of 83 patients diagnosed with oral cavity squamous cell carcinoma were reviewed retrospectively to determine frequency of intraglandular lymph nodes in submandibular gland [submandibular gland metastasis] and incidence and mechanism of submandibular gland involvement by oral cavity squamous cell carcinoma. The overall incidence of cervical metastasis was 56.4%, of whom majority had level I metastasis. Submandibular gland involvement via direct invasion from the anatomical proximity of T4a tumors or extra nodal extension from level 1b node was evident in 6 patients. Despite the high incidence of level I metastasis, lymphatic metastases to submandibular gland itself are unlikely based on absence of intraglandular lymph nodes. The results suggest the feasibility of preserving the submandibular gland in early-stage oral cavity carcinoma unless the tumor extends level 1b with extra nodal extension.