Incidence of Submandibular Gland Involvement in Oral Cancer Patients with Positive Lymph Nodes: Experience at a Tertiary Cancer Centre in South India

Dhara, Vasantha; Bejjihalli, Rajani; Hoda, Nadimul; Kortikere, Sabitha; Ghosh, Subhabrata; Annavarjula, Vinitha

doi:10.30476/mejc.2022.87845.1442

Incidence of Submandibular Gland Involvement in Oral Cancer Patients with Positive Lymph Nodes: Experience at a Tertiary Cancer Centre in South India

Document Type : Original Article(s)

Authors

Vasantha Dhara

Rajani Bejjihalli

Nadimul Hoda

Sabitha Kortikere

Subhabrata Ghosh

Vinitha Annavarjula

Oral Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India

https://doi.org/10.30476/mejc.2022.87845.1442

Abstract

Background: Routine excision of submandibular gland along with level Ib lymph nodes is carried out as a part of standard neck dissections. The current study aimed to evaluate the incidence of submandibular gland involvement in oral squamous cell carcinoma cases undergoing neck dissections with clinically positive nodes.
Method: We carried out a retrospective observational experiment. The records of 520 patients diagnosed with oral cavity squamous cell carcinoma, who underwent neck dissection, were retrospectively reviewed. We recorded the incidence of submandibular gland involvement by the primary tumour.
Results: Metastasis to level 1 lymph nodes was found in 35.6% of the patients. The involvement of submandibular gland in our study sample was 0.96%.
Conclusion: Recent literature has recommended sparing of the submandibular gland in certain cases; that is, because its removal causes postoperative xerostomia with exaggeration due to radiotherapy, which is considered morbid, based on various anatomical models. However, this finding is controversial. Our study suggested submandibular gland sparing neck dissections in all subsites, except for tongue, anterior alveolus, and floor of mouth tumours.

Keywords

Submandibular gland

Oral cancer

Neck dissection

Xerostomia

How to cite this article:

Dhara V, Bejjihalli R, Hoda N, Kortikere S, Ghosh S, Annavarjula V. Incidence of submandibular gland involvement in oral cancer patients with positive lymph nodes: Experience at a tertiary cancer centre in south India. Middle East J Cancer. 2022;13(3):500-6. doi: 10.30476/mejc.2022.87845.1442.

Crile G. Landmark article Dec 1, 1906: Excision of cancer of the head and neck. With special reference to the plan of dissection based on one hundred and thirty-two operations. By George Crile. 1987;258(22):3286-93. doi: 10.1001/jama.258.22.3286.
Bocca E, Pignataro O. A conservation technique in radical neck dissection. Ann Otol Rhinol Laryngol. 1967;76(5):975-87. doi: 10.1177/000348946707600508.
Ramirez-Amador V, Silverman S Jr, Mayer P, Tyler M, Quivey J. Candidal colonization and oral candidiasis in patients undergoing oral and pharyngeal radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(2):149-53. doi: 10.1016/s1079-2104(97)90061-5.
Kies MS, Haraf DJ, Rosen F, Stenson K, List M, Brockstein B, et al. Concomitant infusional paclitaxel and fluorouracil, oral hydroxyurea, and hyperfractionated radiation for locally advanced squamous head and neck cancer. J Clin Oncol. 2001;19(7):1961-9. doi: 10.1200/JCO.2001.19.7.1961.
Basaran B, Ulusan M, Orhan KS, Gunes S, Suoglu Y. Is it necessary to remove submandibular glands in squamous cell carcinomas of the oral cavity? Acta Otorhinolaryngol Ital. 2013;33(2):88-92.
Malik A, Nair S, Nair D, Chaturvedi P. A prospective study to evaluate the pattern of lymphatic metastasis in relation to submandibular gland in the patients with carcinoma of the oral cavity. Eur J Cancer. 2016; 38(11):1703-07.
Dundar Y, Mandle Q, Raza SN, Lin HS, Cramer J, Hotaling JM. Submandibular Gland Invasion by Oral Cavity Cancers: A Systematic Review. Otolaryngol Head Neck Surg. 2019;161(2):227-34. doi:10.1177/0194599819838475.
Razfar A, Walvekar RR, Melkane A, Johnson JT, Myers EN. Incidence and patterns of regional metastasis in early oral squamous cell cancers: feasibility of submandibular gland preservation. Head Neck. 2009;31(12):1619-23. doi:10.1002/hed.21129.
Kruse A, Grätz KW. Evaluation of metastases in the submandibular gland in head and neck malignancy. J Craniofac Surg. 2009;20(6):2024-7. doi:10.1097/SCS.0b013e3181be87a3.
Spiegel JH, Brys AK, Bhakti A, Singer MI. Metastasis to the submandibular gland in head and neck carcinomas. Head Neck. 2004;26(12):1064-8.
Cakir Cetin A, Dogan E, Ozay H, Kumus O, Erdag TK, Karabay N, et al. Submandibular gland invasion and feasibility of gland-sparing neck dissection in oral cavity carcinoma. J Laryngol Otol. 2018;132(5):446-51. doi: 10.1017/S0022215118000592.
Chen TC, Lo WC, Ko JY, Lou PJ, Yang TL, Wang CP. Rare involvement of submandibular gland by oral squamous cell carcinoma. Head Neck. 2009;31(7):877-81. doi:10.1002/hed.21039.
Hughes PJ, Scott PM, Kew J, Cheung DM, Leung SF, Ahuja AT, et al. Dysphagia in treated nasopharyngeal cancer. Head Neck. 2000;22(4):393-7.
Cunning DM, Lipke N, Wax MK. Significance of unilateral submandibular gland excision on salivary flow in noncancer patients. Laryngoscope. 1998;108(6):812-5.
Bruce SD. Radiation-induced xerostomia: how dry is your patient? Clin J Oncol Nurs. 2004;8(1):61-7. doi:10.1188/04.CJON.61-67.
Jaguar GC, Lima EN, Kowalski LP, Pellizon AC, Carvalho AL, Alves FA. Impact of submandibular gland excision on salivary gland function in head and neck cancer patients. Oral Oncol. 2010;46(5):349-54.
Jacob RF, Weber RS, King GE. Whole salivary flow rates following submandibular gland resection. Head Neck. 1996;18(3):242-7.
DiNardo LJ. Lymphatics of the submandibular space: an anatomic, clinical, and pathologic study with applications to floor-of-mouth carcinoma. Laryngoscope. 1998;108(2):206-14. doi:10.1097/00005537-199802000-00009.
Junquera L, Albertos J, Ascani G, Baladrón J, Vicente J. Involvement of the submandibular region in epidermoid carcinoma of the mouth floor. Prospective study of 31 cases [in Italian]. Minerva Stomatol. 1999;49 (11):521-5.
Guney E, Yigitbasi OG. Functional surgical approach to the level 1 for staging early carcinoma of the lower lip. Otolaryngol Head Neck Surg. 2004;131(4):503-8.
Truffert P. Le cou: anatomie topographique. Les apone´vroses, les loges. Paris: Arnette; 1922.
Dhiwakar M, Ronen O, Malone J, Rao K, Bell S, Phillips R, et al. Feasibility of submandibular gland preservation in neck dissection: A prospective anatomic-pathologic study. Head Neck. 2011;33(5):603-9. doi: 10.1002/hed.21499.
Seikaly H, Jha N, Harris JR, Barnaby P, Liu R, Williams D, et al. Long-term outcomes of submandibular gland transfer for prevention of postradiation xerostomia. Arch Otolaryngol Head Neck Surg. 2004;130(8):956-61. doi: 10.1001/archotol.130.8.956.
Fives C, Feeley L, Sadadcharam M, O'Leary G, Sheahan P. Incidence of intraglandular lymph nodes within submandibular gland, and involvement by floor of mouth cancer. Eur Arch Otorhinolaryngol. 2017;274(1):461-6. doi: 10.1007/s00405-016-4205-0.
Lanzer M, Gander T, Lubbers HT, Bredell M, Reinisch S. Preservation of ipsilateral submandibular gland is ill advised in cancer of the floor of the mouth or tongue. Laryngoscope. 2014;124:2070-4.