Metastasis to the submandibular gland in head and neck squamous cell carcinomas: myth or reality?
Keywords:
salivary gland metastasis, submandibular gland metastasis.Abstract
Introduction: very few studies have been published about the possibility of metastasis to the submandibular gland in head and neck squamous cell carcinomas.
Objective: identify the latest scientific evidence about the possibility of metastasis to the submandibular gland in head and neck squamous cell carcinomas.
Methods: a meta-analytical study was conducted based on a retrospective search of papers published in the databases PUBMED, MEDLINE, COCHRANE and HINARI from 2003 to 2013, as well as in the journals Acta of Otolaryngology, Journal of Otolaryngology, Journal of Laryngology and Otology, Journal of Cranio-Maxillo Surgery, International Journal of Oral and Maxillofacial Surgery, Head and Neck, and Annals of Surgical Oncology, using the following search terms: "metastasis from head and neck squamous cell carcinomas", "metastasis to salivary glands", "metastasis to the submandibular gland" and "malignant tumors of the submandibular gland", without any language restrictions. Papers were selected which met the above criteria and referred to the following contents in their materials and methods section: cervical lymph node surgery and dissection as the first onco-specific treatment, anatomopathological study to complete the diagnosis, and a clear statement of the authors' opinions in the discussion of the study. The papers included had been published in the previous 10 years.
Data analysis and integration: a meta-analytical study was conducted of 12 series of patients with head and neck carcinomas for a metapopulation of 2 483 patients. Only 3 cases were found of metastasis to the submandibular gland, representing 0.12 % of the total cases, that is, 1 for every 827 cases. A meta-sample of 848 glands were analyzed within the series in which they were reported, and only 0.35 % presented metastasis.
Conclusion: the study suggests that head and neck carcinomas metastasize to the submandibular gland with an almost null frequency, which may point to the preservation of the submandibular gland in cervical lymph node dissections.
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