Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Submandibular Gland Preservation in Oral Cavity Squamous Cell Carcinomas Our Analysis at A Tertiary Care Hospital

Document Type : Original

Authors
Shahid Rasool 1
Ayushi Manghani 1
Shilpam Sharma 1
Zohda Tayyaba 1
Sabina Khan 2
Zarreen Parvez 1
Neha Dhillon 1
Khaja Naseeruddin 1
Shamaaila Aftab 1
Arsal Usman 1
Hafsa Khan 1
1 Department of Ent- Head and Neck Surgery, Hamdard Institute of Medical Sciences, New Delhi, India.
2 Department of Pathology, Hamdard Institute of Medical Sciences, New Delhi, India.
10.22038/ijorl.2024.75754.3608
Abstract
Introduction:
Surgical excision forms the principal treatment of oral cavity squamous cell carcinomas. The comprehensive surgical management consists of Wide Local Excision of the tumor and Neck Dissection with removal of Submandibular gland. The submandibular gland accounts for 70–90 % of unstimulated salivary volume. Its excision as a part of neck dissection has been found to cause high Incidence (21% vs 7%) of postoperative xerostomia. Recent studies have highlighted that the preservation of the SMG is possible and oncologically safe in early-grade OCSCC with N0 neck as the involvement of SMG in such cases is low and its preservation decreases the chances of xerostomia.

 Materials and Methods:
80 subjects were included in the study to estimate the prevalence of metastatic submandibular gland involvement in oral cavity squamous cell carcinomas. The presence of metastasis into the salivary gland was studied and the mechanism/route of involvement was analysed. The comparison was made between the early and advanced tumors for SMG metastasis irrespective of the primary subsite involvement.
Results:
In the current study low prevalence (6.2 %) of metastasis to SMG was seen. It was seen in high-grade      tumors only. None of the early-grade tumors showed any evidence of SMG metastasis. The most common pattern (80%) of glandular involvement was a direct extension from the primary tumor.
 Conclusions:
Our study concludes that SMG preservation neck dissections can be carried out in early-grade OCSCC irrespective of primary tumor site involvement. The advantages of preserving the SMG are multiple. Furthermore, the morbidity is markedly decreased with its preservation without any compromise on oncological safety.
Keywords
Head and neck Squamous cell carcinoma
Submandibular gland excision
Oral cavity tumors
Xerostomia
Neck dissection
Subjects
  1. Shield KD, Ferlay J, Jemal A.The global incidence of lip, oral cavity, and pharyngeal cancers by subsite ,CA Cancer J Clin; 2017; 67:51-64.
  2. Razfar A, Walvekar RR, Melkane A, Johnson JT, Myers EN. Incidence and patterns of regional metastasis in early oral squamous cell cancers: feasibility of submandibular gland preservation. Head Neck. 2009; 31:1619-1623.
  3. Kowalski LP, Bagietto R, Lara JRL, Santos RL, Silva JF Jr, Magrin J Prognostic significance of the distribution of neck node metastasis from oral carcinoma. Head Neck .2000; 22:207–214.
  4. Crile G excision of cancer of the head and neck. With special reference to the plan of dissection based on one hundred and thirty-two operations. JAMA .1987; 258:3286–3293.
  5. Jacob RF, Weber RS, King GE Whole salivary flow rates following submandibular gland resection. Head Neck.1996;18:242–247.
  6. Ebrahim AK, Loock JW, Afrogheh A, Hille J Is it oncologically safe to leave the ipsilateral submandibular gland during neck dissection for head and neck squamous cell carcinoma? J Laryngol Otol.2011; 125:837–840.
  7. Jaguar GC, Lima EN, Kowalski LP, Pellizon AC, Carvalho AL, Alves FA. Impact of submandibular gland excision on salivary gland function in head and neck cancer patients. Oral Oncol 2010; 46:349–54.
  8. Naidu TK, Naidoo SK, Ramdial PK. Oral cavity squamous cell carcinoma metastasis to the submandibular gland. J Laryngol Otol. 2012; 126: 279–84.
  9. Panda NK, Patro SK, Bakshi J, Verma RK, Das A, Chatterjee D. Metastasis to submandibular glands in oral cavity cancers: can we preserve the gland safely? Auris Nasus Larynx. 2015; 42:322–5.
  10. Rouviere H; Tobies MJ, trans. Anatomy of the human lymphatic system. AnnArbor, MI: Edwards Brothers; 1938.
  11. DiNardo LJ. Lymphatics of the submandibular space: an anatomic, clinical, and pathologic study with applications to floor-of-mouth carcinoma. Laryngoscope.1998;108:206–14.
  12. Iype EM, Sebestian P, Mathew A, Balagopal PG, Varghese BT, Thomas S. The role of selective neck dissection (I-III) in the treatment of node negative (N0) neck in oral cancer. Oral Oncol. 2008;44:1134-1138.
  13. Harish K. Neck dissections: radical to conservative. World J Surg Oncol. 2005;3:21.
  14. Lim YC, Lee JS, Choi EC. Perifacial lymph node metastasis in the submandibular triangle of patients with oral and oropharyngeal squamous cell carcinoma with clinically node positive neck. Laryngoscope. 2006;116: 2187-2190.
  15. Robbins KT, Clayman G, Levine PA. Neck dissection classification update revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology–Head and Neck Surgery. Arch Otolaryngol Head Neck Surg. 2002; 128:751-758.
  16. Kruse A, Gratz Evaluation of metastases in the submandibular gland in head and neck malignancy. J Craniofac Surg. 2009; 20: 2024-2027.

 

 

 

 

 

 

 

 

  1. Dhiwakar M, Ronen O, Malone Jl. Feasibility of submandibular gland preservation in neck dissection: a prospective anatomic-pathologic study. Head Neck. 2011; 33: 603-609.
  2. Lim YC, Kim JW, Koh YWl. Perivascular-submandibular lymph node metastasis in squamous cell carcinoma of the tongue and floor of mouth. Eur J Surg Oncol. 2004; 30: 692- 698.
  3. Chen TC, Lo WC, Ko JY, Lou PJ, Yang TL, Wang CP. Rare involvement of submandibular gland by oral squamous cell carcinoma. Head Neck. 2009; 31:877–81.
  4. Malik A, Joshi P, Mishra A, Garg A, Mair M, Chakrabarti S, Nair S, Nair D, Chaturvedi P. Prospective study of the pattern of lymphatic metastasis in relation to the submandibular gland in patients with carcinoma of the oral cavity. Head Neck. 2016; 38:1703–7.
  5. Basaran B, Ulusan M, Orhan KS, Gunes S, Suoglu Y. Is it necessary to remove submandibular glands in squamous cell carcinomas of the oral cavity? Acta Otorhinolaryngol Ital. 2013; 33:88–92.
  6. Dundar Y, Mandle Q, Raza SN, Lin HS, Cramer J, Hotaling JM. Submandibular Gland Invasion by Oral Cavity Cancers: A Systematic Review. Otolaryngol Head Neck Surg. 2019 ;161(2):227-234.
  7. Hemmat SM, Wang SJ, Ryan WR. Neck dissection technique commonality and variance: a survey on neck dissection technique preferences among head and neck oncologic surgeons in the American Head and Neck Society. Int Arch Otorhinolaryngol. 2017;21:8-16.
  8. Gu B, Fang Q, Wu Y, Du W, Zhang X, Chen D Impact of submandibular gland preservation in neck management of early stage buccal squamous cell carcinoma on loco regional control and disease-specific survival. BMC Cancer .2020; 20:1034.
  9. Chen TC, Lou PJ, Ko JY, Yang TL, Lo WC, Hu YL, Wang CP. Feasibility of preservation of the submandibular gland during neck dissection in patients with early-stage oral cancer. Ann Surg Oncol. 2011;18:497–504.
  10. Lanzer M, Gander T, Lübbers HT, Metzler P, Bredell M, Reinisch S. Preservation of ipsilateral submandibular gland is ill advised in cancer of the floor of the mouth or tongue. Laryngoscope. 2014; 124:2070–4.
Iranian Journal of Otorhinolaryngology
Volume 36, Issue 5
September and October 2024
Pages 581-586