Oral cancer patients have a chance of metastasis to the cervical nodes. A prophylactic neck dissection is advised in clinically undetectable necks. The extent of the neck dissection has been in doubt and various levels with a low propensity are usually skipped such as level IIB. Though a routine level IIB node dissection is not suggested in patients with N0 neck, it is often confusing when visible nodes are present in this subgroup.
A prospective analysis of consecutive oral cancer patients was conducted to see for level IIB nodes in an ipsilateral neck dissection.
Forty-four patients underwent a neck dissection, including level IIB, retrieving 165 nodes from level IIB. Stage-wise distribution was 9, 22, 3, and 10 patients in T1, T2, T3, and T4 stages with majority in tongue cancers. An estimated 30 patients had a clinically node-positive disease, but only 18 underwent a modified or radical neck dissection. A pathologically node positive disease was seen in 12 patients, but only two had level IIB positive (0.01%), both of which had positive level IIA nodes.
This study adds to the evidence that the majority of nodes in level IIB are reactive nodes and a metastasis to this group in isolation is unlikely.