Background: Selective neck dissection is done in stage I and II squamous cell carcinoma
of tongue as it has less morbidity compared to comprehensive neck dissection. Even
selective neck dissection has its associated morbidity due to accessory nerve neuropraxia as
a result of dissection around the accessory nerve to clear the Level 2B group of lymph
nodes.
Aim: The aim of the study was to compare the accessory nerve dysfunction in patients who
undewent extended supraomohyoid neck dissection with or without level 2B dissection
Methods:60 patients with stage I and stage II oral tongue cancers were selected, they
were randomized into two groups; Patients in the study group had removal of neck nodes
from levels 1 to 4 avoiding level 2B group of neck nodes. Patients in the control group had
an extended supraomohyoid neck dissection. At three weeks and at nine months
postoperatively the function of the accessory nerve is evaluated clinically and by EMG.
Results:On final histopathological examination 9 patients had positive neck nodes.
5\9 (55%) patients had metastasis in level 1B alone. 2 \9 (22%) patients had metastasis in
level 2A alone.
Two patients had metastasis in multiple levels, 1B and 2 A levels in one patient and 2 A and
3 levels in the other.
None of the 30 patients in the control group had level 2B positivity.
6\30 (20%) patients in the control group and 4\30 (13%) in the study group had accessory
nerve dysfunction on first post operative EMG.
3\30 (10%) patients of the control group had EMG changes even at 9 months; all the
patients in the study group had a normal EMG at the end of 9 months
Conclusions: 1 In stage 1 and II oral tongue cancers level 2B nodal involvement is rare.
2 Permanent accessory nerve damage can be avoided by avoiding level 2 B dissections.