Patterns of lymph node metastases to the submuscular recess.

Objective: To determine the incidence of lymph node metastases in the submuscular recess (level 2B) in selective neck dissections. The goal was to evaluate the oncologic need for dissection in this area owing to the increased morbidity from devascularization of the spinal accessory nerve.

Methods: A prospective analysis of 74 patients who underwent 80 neck dissections from July 2002 to March 6, 2004, was undertaken. Seventy-six of the 80 neck dissections were performed in patients with squamous cell carcinoma, whereas the remainder were done for papillary carcinoma of the thyroid. All submuscular recess specimens were sent separately from the remainder of the neck dissection. The location of the primary tumour, staging, presurgical radiation status, and the number of nodes in both specimens were recorded.

Results: Forty-six percent (37 of 80) of the neck dissections were positive for malignancy. Of the 80 neck dissections, 8.75% (7) had positive nodes in the submuscular recess. All patients with disease in the submuscular recess were preoperatively staged as N2B or greater.

Conclusion: Our data suggest that dissection of the submuscular recess in patients with squamous cell carcinoma of the head and neck may be warranted only in patients with N2B disease or greater.