Elective neck dissection in early oral squamous cell carcinoma:necessary?

Aim:The indication of neck dissection in oral squamous cell carcinoma(OSCC)is a problem of risk-benefit evaluation between probability of neck metastases,the problem of complications associated with neck dissection and the prognostic influence of delayed diagnosis of metastasis during follow-up.There is no consensus on the elective treatment of the neck in early oral cancer patients with a clinically N0(cN0)neck.Methods:The author performed a search of PubMed articles with the words"elective neck dissection vs.observation","node negative neck"and"early stage oral squamous cell carcinoma".The author selected those articles that studied the early OSCC(T1-T2),and elective neck treatment was compared with clinical observation.Results:Many studies have compared the outcome of elective neck dissection(END)to observation of the neck in early OSCC.The results of them are described.The biologic aggressiveness of oral cavity squamous cell carcinoma,particularly in the early stages,is reflected in its ability to metastasize to regional lymph node chains.Many pretreatment imaging techniques to diminish the incidence of occult metastases haven been studied,and comparative studies have shown ultrasound guided fine needle aspiration cytology(USgFNAC)to be the most accurate.Conclusion:A few non-randomized studies have shown no advantages of END when strict USgFNAC follow-up was employed.Thus,if routine strict follow-up using USgFNAC by a well-trained ultrasonographer cannot be assured,END is the safest strategy.

Double-paddled pectoralis major myocutaneous flap as an alternative to microvascularized free flaps in complex orocervical defects

The authors present the double-paddled pectoralis major myocutaneous flap as a successful alternative for the reconstruction of complex orocervical defects following failure of prior microvascularized free flaps or free flap harvest is not feasible. This method was used for the reconstruction of post-ablative defect in a 36-year-old male with a T4 squamous cell carcinoma of the base of tongue with laryngeal involvement. The distal paddle was adapted to reconstruct a defect of the floor of the mouth and further sutured in two layers (muscle-basal mandible and skin paddle-oral mucosa) while the proximal skin paddle was used to close the cervical skin and the peri-tracheostomy defect.