Metastasis to the submandibular gland in oral cavity squamous cell carcinoma

Tesuven Naidu, SK Naidoo

Abstract


Oral cavity squamous cell carcinoma (SCC) accounts for 10-15% of all head and neck cancers.1 The current treatment for oral cavity SCC is wide local excision of the primary tumour and simultaneous neck dissection which would entail clearance of the first echelon lymph nodes including the submandibular gland for both prophylactic and therapeutic management of the neck. The most significant prognostic factor in the treatment of patients with oral cavity SCC is the status of the cervical lymph nodes.2 Even a single lymph node metastasis may diminish survival by approximately 50%.3 Consequently neck dissection forms an integral aspect of the surgical treatment of oral cavity SCC and has evolved from radical to more selective and functional procedures with our improved understanding of the distribution of regional metastasis. Because the submandibular gland is located in level Ib, with 6 sub-groups of lymph nodes around/within the gland, the submandibular gland is usually removed regardless of the type of neck dissection performed.4

The submandibular glands are responsible for about 70% to 90% of unstimulated salivary volume, especially at night and removal of the gland causes xerostomia to some degree even in patients who do not receive post operative radiotherapy.5 Saliva is not only important for lubrication of the oral cavity but is also vital for antimicrobial activity in the mouth, re-mineralization of teeth, maintenance of the oral mucosal immunity and preparation of the bolus of food during mastication.6

The limited data available in the literature indicate that the true involvement of the submandibular gland in primary oral cavity SCC is uncommon.6,8,9,10,11 Therefore the submandibular gland might be innocent and might be considered for preservation in the surgical treatment of oral cavity SCC.