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Clinical Challenges in Otolaryngology
March 1998

Selective Neck DissectionThe Challenge of Occult Metastases

Author Affiliations


Arch Otolaryngol Head Neck Surg. 1998;124(3):353. doi:10.1001/archotol.124.3.353

AT OUR institution, we have observed that patients with head and neck squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and supraglottic larynx have a 15% to 20% (or greater) probability of occult cervical node metastasis that is not detectable in the results of physical examination or computed tomography. The likelihood of occult spread to these nodes increases with increasing tumor size and thickness. Although the optimal treatment of these patients continues to be controversial and unresolved by a prospective, randomized, multisite, clinical trial, I believe that when the primary lesion is treated surgically, the patient should be encouraged strongly to accept the recommendation for a selective neck dissection.

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