Evaluation of Risk Factors for Level V in Oral Cavity squamous cell carcinoma.

Level V lymph node (LN) dissection has been significantly associated with postoperative shoulder dysfunction as a sequel of spinal accessory nerve (SAN) dysfunction. The aim of study was to determine the role of level V LN dissection in clinically node positive (cN+) oral cavity cancer. We have prospectively evaluated 20 patients of oral cavity squamous cell carcinoma (SCC). During neck dissection, the contents of the level V LN were dissected, labelled, and processed separately from the neck dissection specimen. We studied the prevalence of histopathologic metastasis to level V nodes in clinically node negative cN0, cN1 and cN2 groups. Potential risk factors for the involvement of level V LN were also analysed. Of 20 cases, 11 were cN0. and none of cNo patients had level V metastases and 7were cN1 and 2 with cN2. Amongst cN1 (7) cases, cN1 with palpable level lb LN (5), and none of them had level V LN involvement but cN1 with palpable II/III LN (2), had level V LN involvement. 2 patients from cN2 group had level V LN involvement Over all level V LN involvement was 4 %. Tongue was the most common site to give rise to level V LN metastases and extra capsular spread (ECS) was present in 100 % patient with level V LN metastases. Thus, we concluded that, apart from cN0, patients with cN1 oral cavity cancer with level lb as only site, carefully selected cases could safely undergo SND. Potential risk factors for level V LN metastases are clinically evident ECS, multiple LN involvement and cN1 with deep jugular chain ofpositive, Level V LN, metastasis, Selective neck diss LN involvement.