The N0 Neck in Oral Squamous Cell Carcinoma A Comprehensive Review and Update on Diagnosis and Management

Oral cavity cancer represents one of the most devastating diseases worldwide, as the morbidity and mortality associated with it can be quite significant. Spread to cervical lymph nodes represents a major contributor to patient prognosis, however, despite many technological advances, accurate and consistent identification of involvement of the neck in early stage oral squamous cell carcinoma remains a major challenge. With increasingly sensitive and specific imaging modalities, cytological analysis, as well as sentinel node biopsy, identification of regional cervical metastasis continuously improves. The spread of this disease to regional lymph nodes of the neck often results in dramatic changes in treatment and prognosis, and thus management of the neck in early oral cancer is of paramount importance. A consensus on the ideal treatment modality for the clinically node-negative neck still eludes us, with elective neck dissection at the time of primary treatment being the current gold standard, with radiation and chemotherapy having adjunctive roles. The “wait and see” philosophy also has its advocates, as well as its critics. Advances in genetic analysis of tumours may represent the future in patient-specific intervention. This article represents a review of past, present, as well as future advances in the diagnosis and management of the N0 neck in oral cancer, highlighting the most recent research, techniques, and practices worldwide. keywords: