The Rate of Submandibular Gland Involvement in Oral Squamous Cell Carcinoma

Publication date: Available online 22 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Shuang Yang, Xiao Wang, Jia-Zeng Su, Guang-Yan Yu

Abstract

Purpose

Whether the submandibular gland (SMG) can be preserved during neck dissection in surgical treatment of oral squamous cell carcinoma (OSCC) is controversial. Here, we investigate the SMG involvement rate and provide a basis for preserving the submandibular gland during neck dissection in appropriate cases of OSCC.

Methods

A comprehensive systematic review was conducted on the PubMed/MEDLINE, Embase, and Cochrane Library databases for studies on SMG involvement in OSCC published prior to December 2017 with data analysis technique. The predictor variables were the number of subjects and resected SMG, primary site and tumor-node-metastasis (TNM) stage. The outcome variables were the number of involved SMGs and the mode of involvement. Other variables, i.e., first author, publication year, mean age, the condition of neck lymph nodes at level Ib, were also extracted. A random effect model was used to analyze the rate of SMG involvement in OSCC.

Results

Twelve studies involving a total of 2126 patients with oral squamous cell carcinoma who underwent neck dissection were included in the study. Fifty-two SMGs were involved, and the pooled involvement rate was 2% (I² = 73%, 95% confidence interval [CI]: 1–3%). Forty-eight SMGs were involved via direct spread from the primary site and/or extracapsular spread of positive lymph nodes, and the pooled involvement rate was 1.9% (I² = 72%, 95% CI: 0.9–3.1%). Except for direct spread, four SMGs were involved via intraglandular lymph node or carcinoma growing along Wharton ducts, and the pooled involvement rate was only 0.1% (I² = 0%, 95% CI: 0–0.2%).

Conclusions

The rate of SMG involvement in OSCC is very low, and the most common mode of involvement is by direct spread. The SMG might be preserved during neck dissection in OSCC when it is unlikely be involved through direct spread.

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