Abstract
Excision of submandibular gland is currently victim in all neck dissections. In this study we intend to estimate the prevalence of submandibular gland involvement in squamous cell oral carcinomas and identify the factors associated with it. This is a single institutional, retrospective observational study conducted from 22 to 2018 to 28 February 2020. 317 patients were included for analysis as per study criteria. The prevalence of involvement of submandibular gland was 3.8%. Increased risk of submandibular gland involvement was associated with involvement of level-Ib nodes (Odds ratio: 13.6, 2.9–63.3, 95% CI and p = < 0.001) and presence of extra-nodal extension (Odds ratio: 67, 8.4–532, 95% CI and p = < 0.001) and perineurial invasion (Odds ratio: 5, 1.6–16.8 and p = 0.003). In oral cancers, especially early stage carcinoma of buccal mucosa, submandibular gland preservation may be feasible in absence of extra-nodal extension and level-Ib involvement.
Similar content being viewed by others
References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (2020) Global Cancer Statistics 2020: GLOBOCON Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians. ;71:209 – 49
Shah JP (2009) GilZ. Current concepts in management of oral cancer surgery. Oral Oncol 45:394–401
D’Cruz AK, Vaish R, Kapre N et al (2015) Head and neck disease management group. Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 373:521–529
Dhiwakar M, Ronen O, Malone J, Rao K, Bell S, Phillips R et al (2011) Feasibility of submandibular gland preservation in neck dissection: a prospective anatomic-pathologic study. Head Neck 33:603–609
Jaguar JC, Lima EN, Kowalski LP, Pellizon AC, Al C, Alves FA (2010) Impact of submandibular gland excision on salivary gland function in head and neck cancer patients. Oral Oncol 46:349–354
Altuntas OM, Özer F, Kuscu O, Suslu N (2021) ;83:341 – 46
Mathur P, Satishkumar K, Chaturvedi M, Das P, Sudarshan KL, Santappan S et al (2020) Cancer Statistics, 2020: report from National Cancer Registry Programme, India. JCO Global Oncol 6:1063–1075
Sharma P, Deb T, Ray JG, Kumar A, Gupta G, Das A, Srivatsava S (2018) Oral squamous cell carcinoma profile in North-eastern regions of India from habits to histopathology: a hospital-based study. Natl J Maxillofac Surg 9:56–60
Bernier J, Cooper JS, Pajak TF, Bourhis J, Arlene Forastiere EM, Ozsahin et al (2005) Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of EORTC (#22931) and RTOG (#9501). Head Neck 27:843–850
Harish K (2005) Neck dissections: radical to conservative. World J Surg Oncol 3:21
Yang S, Wang X, Su JZ, Yu GY (2019) Rate of Submandibular Gland involvement in oral squamous cell carcinoma. J Oral Maxillofac Surg 77:1000–1008
Rouviere H, Tobies MJ (1939) translator. Anatomy of Human Lymphatic System. Ann Arbor, MI:Edwards Brothers
DiNardo LJ (1998) Lymphatics of submandibular space: an anatomic, clinical and pathologic study with applications to floor of mouth carcinoma. Laryngoscope 108:206–214
Yang S, Su JZ, Gao Y, Yu GY (2020) Clinicopathological study of involvement of the submandibular gland in oral squamous cell carcinoma. Br J Oral Maxillofac Surg 58:203–207
Springborg LK, Møller MN (2013) Submandibular gland excision: long-term clinical outcome in 139 patients operated in a single institution. Eur Arch Otorhinolaryngol 270:1441–1446
Berini-Aytes L, Gay-Escoda C (1992) Morbidity associated with removal of submandibular gland. J Craniomaxillofac Surg 20:216–219
Dundar Y, Mandle Q, Raza SN, Lin HS, Cramer J, Hotaling JM (2019) Submandibular gland invasion by oral cavity cancers: a systemic review. Otolaryngol Head Neck Surg 161:227–234
Chen TC, Lo WC, Ko JY, Lou PJ, Yang TL, Wang CP (2009) Rare involvement of submandibular gland by oral squamous cell carcinoma. Head Neck 31:877–881
Malik A, Joshi P, Mishra A, Garg A, Mair M, Chakrabarti S, Nair S, Nair D, Chaturvedi P (2016) Prospective study of pattern of lymphatic metastasis in relation to submandibular gland in patients with carcinoma of oral cavity. Head Neck 38:1703–1707
Takes RP, Robbins KT, Woolgar JA et al (2011) Questionable necessity to remove submandibular gland in neck dissection. Head Neck 33:743–745
Nair D, Mair M, Singhvi H, Mishra A, Nair S, Agrawal J et al (2018) Perineural invasion: independent prognostic factor in oral cancer that warrants adjuvant treatment. Head Neck 40:1780–1787
Chen TC, Lou PJ, Ko JY, Yang TL, Lo WC, Hu YL et al (2011) Feasibility of submandibular gland during neck dissection in patients with early stage oral cancer. Ann Surg Oncol 18:497–504
Du W, Fang Q, Liu S, Chen D, Luo R, Zhang X (2020) Feasibility of Submandibular Gland Preservation in cT1-2N0 squamous cell carcinoma in the floor of the Mouth. Front Oncol 10:579
Funding
No funding required.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
Ethical approval was taken from the Institution Ethics Committee. All procedures were in accordance with the ethical standards of the institution.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Rahman, T., Khandelwal, K., Bannoth, S. et al. Submandibular Gland in Neck Dissection: Necessary Fatality or Unfortunate Prey?. Indian J Otolaryngol Head Neck Surg 75, 789–793 (2023). https://doi.org/10.1007/s12070-023-03478-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12070-023-03478-x