Management of the N0 Neck in Oral Cancer

Purpose of Review This review critically examines the best evidence-based management for the clinically N0 (cN0) neck in oral squamous cell carcinoma. Recent Findings There is much controversy regarding the management of the cN0 neck with three main treatment paths being advocated. These are the excision of the primary oral cancer with close observation of the neck, excision of the primary combined with elective neck dissection, and the use of sentinel node biopsy. Recent studies suggest that patients with primary cancers who have undiagnosed occult nodal metastases benefit from elective supraomohyoid neck dissection. Depth of invasion of the primary and T stage defines high-risk patients for nodal disease. The use of adjuvant therapy is dictated by surgical histopathology. Summary Elective supra-omohyoid neck dissection is currently indicated if the risk of occult neck nodes is > 20%. The role of sentinel node biopsy is still being defined.