Basic And Clinical Research Of Dissection Of Submandibular Triangle:Investigating The Feasibility Of Pslateral Submandibular Gland Preservation During Neck Dissection In Patients With Early-Stage Oral Cancer

Objective To study the incidence of oral carcinoma metastasis to the submandibular gland, as well as the incidence of lymph nodes inside the submandibular gland, for investigating the feasibility of ipsilateral submandibular gland preservation during neck dissection in patients with early-stage oral cancer.Methods78patients undergoing89neck dissections were studied by dissection, histological examination and imaging examination. All submandibular gland specimens were continuously sectioned and observed histologically after hematoxylin and eosin staining. To find out whether there are lymph nodes inside the submandibular gland, to study the distribution and metastasis of submandibular lymph nodes, and to study the contribution of MRI in showing the metastasis from oral carcinoma to cervical lymph nodes. All of these were confirmed by pathological reports after operation.Results There were neither metastatic neoplasm nor lymph nodes found inside the submandibular gland. Oral squamous cell carcinomas made the most of the patients undergoing neck dissections in our department, accounting for93.6per cent (73/78cases). There were4lymph nodes in submandibular triangle in general. From the distribution of submandibular lymph nodes, the constituent ratio as well as the metastasis ratio of which beside the anterior facical vein was the highest, accounting for95.5per cent (85/89lateral) and13.5per cent (12/89lateral) respectively.44.9per cent (40/89lateral) of89lateral of neck dissection had postoperative pathology-proved ipsilateral cervical lymph node metastasis. The relevance ratio of MRI in showing cervical lymph node metastasis was40percent (16/40).Thus, compared to pathological report, the coincidence rate of MRI in diagnosing cervical lymph node was51.7percent ((30+16)/89)Concluson There were neither metastatic neoplasm nor lymph nodes found inside the submandibular gland in this study. According to literatures reviewed, submandibular gland metastasis from oral carcinoma is extremely rare, except in patients with a primary tumour in close relation to the gland and direct spreading into the gland. So, we infer that preservation of the ipsilateral submandibular gland during neck dissection is oncologically safe, except in patients with prior surgery or radiotherapy, or a primary tumour in close relation to the gland. However, it requires higher skill for the operation. The operator should preserve the founction of the submandibular gland, meanwhile clear the lymph nodes around the gland thoroughly.