1990 Volume 36 Issue 11 Pages 2518-2526
Metastasis of maxillary carcinoma to the cervical lymph nodes was investigated in 107 patients who had been treated at the 2nd Department of Oral and Maxillo-facial Surgery, Tokyo Medical and Dental University from 1975 to 1988.
Primary metastasis to the cervical lymph nodes at the initial visit was found in 10 out of 107 patients (9. 3%) and secondary metastasis after treatment was found in 20 out of 97 patients (20. 6%). The overall rate of cervical metastasis was 28. 3%(30/107).
Five years cumulative survival rate of total 107 cases was 55.0%, however, the survival rate in the patients with primary metastasis was low as 12. 5% in 2 years and that of the patients with secondary metastasis was also low as 23. 2% in 5 years. Therapeutic radical neck dissections were performed in 21 out of 30 metastatic cases, and histologically positive nodes were proved in 19 cases (90. 5%). The overall tumor control rate in the cervical lymph nodes was 60% for primary metastasis and 42. 1% for secondary metastasis.
Examinations on the histological features of squamous cell carcinoma of primary metastatic type revealed that cervical lymph node metastases found in 83. 3% of the cases examined were classified into Grade 4D according to the mode of invasion and Grade la according to the malignancy grading by WHO. The rates of opposite side metastasis and of multiple metastasis were higher in carcinomas originating from the upper alveolus and gingiva than carcinomas from the maxillary sinus. The superior internal jugular nodes were most frequently metastasized and then submandibular nodes.
From these results the following conclusions could be drawn: a complete treatment for the primary site is required and radical neck dissection is essential for cervical metastasis. Furthermore, prophylactic neck dissection may be indicated in some cases for the control of cervical metastasis of maxillary carcinomas.
