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Incidence of level IV nodal metastasis in oral squamous cell carcinoma - A retrospective study in South Indian patients presenting in an oral cancer institute (2016-2017)

A. Melvin George , Rinku George


The aim of this study was to retrospectively analyze the incidence of histopathologically positive level IV nodal metastasis in oral squamous cell carcinoma (SCC) with respect to T stage of primary tumor, primary site of tumor, and clinical nodal staging. All operated oral SCC case files from 2016 till present date were analyzed. Data included were patient age, habits, primary site of tumor, T stage, clinical N stage, neck dissection performed, number of nodes harvested, and histopathologically positive infiltration in level IV. Statistical analysis was done using SPSS software version 20. Chi-square test was used to find the association between the variables. A total of 30 patients were included. 22 patients underwent modified radical neck dissection (MRND) Type II neck dissection, while 6 patients underwent MRND Type III and 2 patients who underwent SOND were not included in the study. Nodal metastasis in level IV was observed in 3 patients. All of these three patients had T4a lesions. 1 of 6 tongue (P = 0.002) CA patients and 2 of 2 CA maxillary alveolus had metastasis in level IV (P = 0.002). None of the patients with clinical N0 or N1 nodal staging had histopathological evidence of infiltration in level IV. Of the 9 patients who had earlystage lesions, 6 were tobacco users. It was found that none of them had level IV metastasis. Furthermore, it was observed that irrespective of the site involved, T4 lesions had the highest risk of metastasis to level IV nodes. The results of this study show that the incidence of level IV metastasis is comparable to that of western countries.

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