Recent trend of level iib nodal metastases in oral and laryngeal cancers: prospective study and systemic review of literature

To determine positivity of lymph nodal metastases at level IIb in patients with oral and laryngeal cancers undergoing neck dissection Design: Prospective study Setting: Academic tertiary care referral center Patients: 50 patients undergoing neck dissection for oral and laryngeal cancer between June 2, 2008 and November 30, 2010, were prospectively analyzed. Patients with a history of neck dissection or whose pathology reports did not clearly distinguish the level IIb from other nodal levels were excluded from study. Interventions: Patients underwent neck dissection based on primary tumor site and well established regional lymphatic drainage patterns. Main outcome measure: Presence of histopathologically proven nodal disease at level IIb Results: Fifty patients underwent 61 neck dissections, 11 of which were bilateral. The prevalence of metastases at level IIb was 0% (0/23) in clinically No necks and 15.79% in clinically node positive necks(6/38) with overall incidence of 9.8%(6/61).there was no isolated metastases at level IIb .There was a stastically significant association between level IIa and IIb metastases(p=0.00). No significant association observed between metastases at level IIb and primary tumor site (p=0.398) and clinical N stage (p=0.075) Conclusion: The results of present study suggest that positivity of level IIb nodal metastases is rare in patients of oral and laryngeal cancer who underwent neck dissections.