Oral Squamous Malignancy By Anatomic Site Anatomic Sites

The parameters of oral cavity as defined by the American Joint Committee on Cancer (15) include the region extending from the circumferential mucocutaneous border of the lips to the junction of the hard and soft palate superiorly and inferiorly to the line of the circumvallate papillae of the tongue (15). The oral cavity is divided into seven areas: the lips, buccal mucosa, upper and lower alveolar ridges, retromolar gingiva (retromolar trigone), FOM, hard palate, and anterior two-thirds of the tongue (oral or mobile). These designated areas allow for assessment and comparison of varied treatment modalities and prognosis. The frequency of oral cancer in these various areas, in descending order, are: lip, oral tongue, FOM, gingival, retromolar trigone, buccal mucosa, and palate. The various areas are considered separately in this chapter.

A number of significant groups of lymph nodes serve as the primary echelon nodes for the oral cavity. Submental lymph nodes are framed in the submental triangle by the anterior bellies of the digastric muscles and the hyoid bone. Subman-dibular lymph nodes are positioned around the submandibular gland in proximity to the lower jaw and facial artery. The upper deep jugular nodes are found along the upper internal jugular vein between the posterior bellies of the digastric muscles and the omohyoid muscles. Two lymph nodes, which frequently herald cancer in the oral cavity, are contained in the upper deep jugular nodes: the uppermost node is the jugular digastric (tonsillar node), and the middle node is the jugular carotid (principle node of the tongue). Lymph nodes less frequently receiving primary lymphatic drainage from the oral cavity are the lateral retropharyngeal and preparotid lymph nodes. Regional metastatic squamous cell carcinoma of the oral cavity frequently proceeds in an orderly fashion from nodes in the upper levels of the neck toward nodes in the lower aspects of the neck with rare exceptions (16,17). Metastatic deposits from the lips, anterior FOM, adjacent gingival, and buccal mucosa tend to present in submandibular nodes. Malignancies located posteriorly in the oral cavity frequently metastasize to the upper deep jugular nodes first and as disease advances to the middle and lower deep jugular nodes. A single metastatic deposit in the lower posterior cervical nodes from the oral cavity from carcinoma is unlikely. There are, however, lymphatic channels that directly connect the oral cavity with lower jugular nodes, which provides an anatomic justification for a lower jugular lymphadenectomy (18).

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