TITLE:
The Management of Maxillary Squamous Cell Carcinoma―A Retrospective Study
AUTHORS:
Yoav Leiser, Keren Yudovich, Michal Barak, Imad Abu El Naaj
KEYWORDS:
Maxillary SCC, Neck Dissection, Prophylactic, Occult Metastasis
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.5 No.12,
October
24,
2014
ABSTRACT: Introduction: Squamous
cell carcinoma (SCC) is the predominant neoplastic tumor that occurs in the
oral cavity. SCC arising from the maxillary gingiva, hard palate and maxillary
alveolus is relatively rare. Since soft tissue barrier is thin, the diagnosis
of cancer in these regions is usually ulcerative and invasive to the underlying
bone already in the early stages of the disease. The aim of the present study
was to retrospectively evaluate our data regarding the management of loco-regional
lymph nodes and the efficacy of neck dissection in the clinically negative neck
when maxillary squamous cell carcinoma is diagnosed. Furthermore, we wish to
establish the role of prophylactic neck dissection and T stage from which it
should be implemented. Methods: Archival records of oncological patients that
were treated for SCC of the maxillary alveolus, hard palate and gingiva were
collected. Overall 20 patients met the inclusion criteria, 11 men and 9 women. Average
age of first diagnosis was 68 years. Results: At initial examination, 2
patients (10%) had clinically positive lymph nodes and undergone therapeutic
neck dissection. The remaining 18 patients had clinically N0 necks. Five
patients (28%) had occult positive lymph nodes following prophylactic neck
dissection. One of the patients had a primary resection with no neck treatment.
This patient eventually developed metastases in the neck two month post-surgery
(occult disease). The overall positive lymph nodes in maxillary squamous cell
carcinoma were 40% (8/20) with an occult metastasis rate of 33% (6/18). Disease
specific mortality was 45% (9/20). Conclusion: In the present study, the
majority of patients that were diagnosed with occult metastatic disease were
either large tumors (T4, 60%) or with moderate to poor differentiation
(mood-poor 80%). We conclude that patients who are present with a high grade (moderate-poor)
large or invasive maxillary SCC (T2-T4), a prophylactic selective neck
dissection (levels I-III) should be performed.