Evaluation of metastases in the submandibular gland in head and neck malignancy.

BACKGROUND : Either excision of the submandibular gland during neck dissection or having the submandibular gland in radiation field can result in xerostomia, leading to reduced quality of life. The purpose of this study was to evaluate the prevalence of metastasis to the submandibular gland and to identify potential risk factors leading to the presence of metastases into the gland. PATIENTS AND METHODS : Of 376 patients with head and neck malignancy who were treated between 1999 and 2008, 130 patients underwent a neck dissection, and in total, 171 submandibular glands were removed. The average age was 61.1 years. RESULTS : Twenty-three patients (17.7%) revealed some type of pathology in the submandibular gland such as chronic sialadenitis (15), atrophy (5), tumor infiltration (5), and intraglandular lymph node (1). In the group with sialadenitis, the mean age was 57.7 years. Forty-four percent had a pretreatment (radiation, 9%; local resection, 13%; or combined therapy, 22%) before neck dissection. Of the sialadenitis group, 9 of 12 patients had the primary tumor in the lower jaw, floor of mouth, or tongue. CONCLUSIONS : One needs to be aware of the possibility of occult metastases in level I in oral cavity carcinomas, whereas oropharynx carcinoma constitutes a lower risk for involvement of lymph node metastases at level I. The excision of the submandibular gland should be performed in cases with positive lymph nodes at level I and in tumor sites with a high risk of occult metastasis at level I.