Preservation of the submandibular gland in lymph node neck dissections
Keywords:
submandibular gland, preservation, neck dissections.Abstract
Introduction: as a result of the swift development of oncology, some therapeutic modifications have recently been considered, among them the potential preservation of the submandibular gland in neck dissections.
Objectives: identify the criteria to surgically preserve the submandibular gland and expound the theoretical scientific foundations allowing to set forth a modification to neck dissection technique with a view to preserving this gland.
Methods: an exhaustive retrospective search was conducted of papers published in the databases Pubmed, Medline, Cochrane and Hinari from January 2009 to July 2014. The journals surveyed were Head and Neck, Otolaryngology and Head and Neck Surgery, and The Laryngoscope. The search terms used were "submandibular gland preservation", "oncological criteria preserve submandibular gland", "modifications cervical lymph node dissections", without any language restrictions. Only papers published in the last five years were included. On the other hand, their materials and methods section should make reference to population studies, neck dissection as an onco-specific treatment, and anatomopathological confirmation of the diagnosis.
Data analysis and integration: three studies with a metapopulation of 829 patients referred to a group of patients with oral and oropharyngeal tumors and simultaneous neck dissections whose submandibular gland had been preserved. These studies do not report any difference as to local, regional or distant relapse or survival when compared with another group of patients in whom neck dissection did not include such a procedure.
Conclusion: all studies referred to the following aspects: the low risk of occult metastasis to the gland from head and neck squamous cell carcinomas, postsurgical xerostomia, and the feasibility of the surgical technique as foundations for the preservation of the submandibular gland. They also referred to the fact that absence of prior onco-specific therapy, positive lymph nodes in sublevel IB, and the relationship between the primary tumor and the gland are all required criteria for the selection of candidates for the procedure.
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