320 BRITISH JOURNAL OF ORAL & MAXILLOFACIAL SURGERY British Journal of Oral and Maxillofacial Surgery (1999) 37, 320–323 © 1999 The British Association of Oral and Maxillofacial Surgeons INTRODUCTION Squamous cell carcinoma (SCC) of the tongue has the most nodal metastases of any oral cancer and nodal involvement considerably lowers survival. 1 Mitchell and Crighton 2 reported a difference in five-year survival of 83% and 33% in T1, and of 63% and 33% in T2 lesions. The extent of nodal spread and prognosis varies depending on whether the body or base of the tongue is affected, and this depends largely on lymphatic drainage. 3–5 The position of the base is such that it is directly drained by the deep cervical chain and, rarely, by posterior cervical lymph nodes. The tip of the body of the tongue is drained by submental lymph nodes while the rest of the body and margins are drained by submandibular lymph nodes. Submental and sub- mandibular lymph nodes are drained by the deep cer- vical chain. Surgical treatment of the neck is therefore essential in the management of these patients. At present, however, despite the high incidence, poor prognosis, and abundance of reports, the correct management still does not seem to have been ade- quately established. To help to shed light on this problem, we reviewed the records of 82 consecutive cases of SCC of the tongue that had been operated on. MATERIALS AND METHODS The records of 82 consecutive patients with SCC of the tongue treated surgically at the Department of Maxillofacial Surgery of the School of Medicine and Surgery of the ‘Federico II’ University of Naples (Naples, Italy) were reviewed retrospectively. Site and size of the tumour and nodal status were assessed according to the TNM classification. 6 The classification suggested by Shah et al. was used to evaluate lymph nodes. 7 Each patient had a radical resection. A margin of 1 cm of uninvolved tissue was considered to be safe. If nodes were involved unilaterally, we did an ipsilateral modified radical and a contralateral prophylactic selective neck dissection. If they were involved bilater- ally, we did a bilateral modified radical neck dissec- tion. A ‘wait-and-see’ policy was adopted if no nodes were involved in T1 lesions while T2–3 lesions were treated by an ipsilateral prophylactic selective neck dissection (with the exception of median lesions, which were treated by bilateral prophylactic neck dis- section). We had no T4 lesions. All patients were followed up for five years or more. The terms used for neck dissection are those used in the classification by Robbins et al. 8 RESULTS Results are shown in Table 1. The male:female ratio was 1.6:1 (50:32 cases), and the peak incidence was in the age group 41–60 years (n=38, 46%). On initial investigation most cases (n=62, 76%), were T1–2, 14 (17%) were T3, and six (7%) were Surgical management of the neck in squamous cell carcinoma of the tongue L. Califano, A. Zupi, G.M.Mangone, F. Longo, G. Coscia, P. Piombino School of Medicine and Surgery, Department of Maxillofacial Surgery, ‘Federico II’ University of Naples, Naples, Italy (Chief: Professor C. Giardino) SUMMARY. If the nodes are involved, survival of patients with squamous cell carcinoma of the tongue is considerably reduced. Surgery remains the treatment of choice and, to define its role, we have reviewed 82 consecutive cases. Sixty-two cases (76%) were T1–2, and 46 patients (56%) had involved nodes. The cervical region II was the most often involved (n=26). Occult nodal metastases were present in 12 cases. The extent of nodal spread and prognosis varies according to whether the body or the base of the tongue is involved. Lesions of the base with involved node should be treated by a selective posterolateral neck dissection, whilst in the case of a lesion of the body of the tongue, the dissection should be selective anterolateral. In lesions of the base, when there are no nodes involved, a prophylactic selective posterolateral neck dissection is recommended, whilst in the case of the lesions of the body, selective supraomohyoid neck dissection in T2–4 lesions is recommended. Table 1 – Squamous cell carcinoma of the tongue according to TN classification N+ N– (pN+)* Body Base Total Body Base Total T1 1 7 8 16 7 (1) 23 (1) T2 11 9 20 2 (1) 9 (8) 11 (9) T3 10 2 12 0 2 (2) 2 (2) T4 5 1 6 0 0 0 Total 27 19 46 18 (1) 18 (11) 36 (12) *Numbers in parentheses are those with occult metastases.