Early-stage oral cavity cancer (T1N0) with lymphatic drainage to the retropharyngeal lymph node: A therapeutic challenge

We report a case of a 54-year-old patient diagnosed with T1N0M0 oral squamous cell cancer located at the right maxillary tuberosity. The treatment plan included wide local excision with partial maxillectomy and sentinel lymph node biopsy. Preoperative single photon emission computed tomography/computed tomography (SPECT/CT) revealed lymphatic drainage to a single ipsilateral retropharyngeal lymph node (Rouvière's node/level VIIa). Due to the poor surgical accessibility of this lymph node, the decision was made to proceed with the tumor resection without sentinel lymph node excision, focusing instead on assessing the tumor's depth of infiltration to estimate the risk of metastasis. Histopathological analysis of the specimen confirmed clear margins with 2mm depth of infiltration. Consequently, the patient was placed under observation. This case represents the first reported instance of sentinel lymph node drainage to Rouvière's node in early oral squamous cell carcinoma, presenting a unique diagnostic and therapeutic challenge.