Level IIB neck dissection in oral squamous cell carcinoma: Science or myth?

Yasmine Ghantous, Sharon Akrish, Morad Abd-Elraziq, Imad Abu El-Naaj

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7 Scopus citations


Selective neck dissection enables us to reduce the morbidity of neck dissection while maintaining the same oncological results, mainly in clinically negative neck N0. The most common morbidity associated with selective neck dissection is spinal accessory nerve dysfunction and related shoulder disability, which are encountered during dissection of level IIB. The aim of authors' study is to evaluate the incidence of sublevel IIB lymphatic metastasis in clinically N0 oral squamous cell carcinoma (OSCC) patients. The study group comprised 48 men (68%) and 22 women (32%). The median number of the lymph nodes removed from level IIB was 6.5. All the investigated necks were clinically classified as N0, of which 14 (20%) turned out to have an occult nodal metastasis, including only 1 patient (1.42%) of level IIB occult metastasis, which originated from the primary tumor located in the tongue and also metastasized to level IIA. The most associated morbidity was shoulder pain and dysfunction, which presented in 60% of the patients. Also, an electronic search was conducted to find relevant studies investigating the prevalence of level IIB metastasis in OSCC. Ten studies were included for full text review, including the current study. The overall incidence of level IIB metastasis is 4% (17 patients); of these 17 patients, only 4 patients had isolated level IIB nodal metastases (2%). To conclude, neck dissecting, including dissecting level IIB, remains the keystone of treating OSCC. Its prognostic and therapeutic value exceeds its associated morbidity; therefore, dissecting level IIB is recommended in treating OSCC in clinically N0 patients.

Original languageEnglish
Pages (from-to)1035-1040
Number of pages6
JournalJournal of Craniofacial Surgery
Issue number4
StatePublished - Jun 2016

Bibliographical note

Publisher Copyright:
Copyright © 2016 Mutaz B. Habal, MD.


  • Incidence
  • Level IIB
  • Morbidity
  • Selective neck dissection
  • Spinal accessory nerve


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