Cervical node metastasis, the most serious prognostic factor in patients with oral carcinoma, remains a challenge to oral surgeons. Radical neck dissection, as systematized by Crile and popularized by Martin et al, was the only surgical treatment available for a long time.
However, considering the functonal and esthetic, damage (outcome) following classical radical neck dissection and its effect on qality of life, new methods of neck dissection such as modified radical neck dissection and selective neck dissection have recently been developed.
Modified radical neck dissection is an attractive approach as it preserves the spinal accsessory nerve, internal jugular vein, and stemocleidomastoid muscle. On the other hand, selective neck dissection is a procedure to remove only node groups at greatest risk for metastasis. The type of neck dissection used varies with tumor stage.
Topographic distribution of lymph node metastasis differs between oral cancer and cancers of the pharynx and larynx. Hence, the procedure of neck dissection for metastasis of oral cancer is somewhat specific. I would like to illustrate three neck dissection procedures, classical radical neck dissection, modified radical neck dissection, and supraomohyoid neck dissection for oral cancer.

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The improvement of survival of oral cancer patients depends upon the control of distant metastasis as well as local tumor. There have been few studies on the onset time of distant metastasis of oral cancer. We studied tumor doubling time (TDT) and onset of distant metastasis from squamous cell carcinoma of the oral cavity in three patients who developed distant metastasis and had X-ray examinations serially.
Case 1 had carcinoma of the buccal mucosa, and underwent radiotherapy initially. After local recurrence occurred, he underwent induction chemotherapy followed by salvage operation, but lung metastasis appeared later. The effect of chemotherapy was NC (no change) . TDT of metastatic tumor was 27 days. The metastasis was thought to have occurred when chemotherapy and surgery were performed for the recurrent tumor.
Case 2 had carcinoma of the tongue. He underwent induction chemotherapy followed by surgery and postoperative radiotherapy, but multiple distant metastasis occurred. The effect of chemotherapy was NC. TDT of metastatic tumor was 75 days. The metastasis was thought to have occurred much earlier than the initial treatment.
Case 3 had carcinoma of the mandibular bone. She underwent induction chemotherapy followed by surgery and postoperative radiotherapy, but local recurrence occurred. The effect of chemotherapy was PD (progressive disease) . She then underwent salvage operation and obtained local cure, but lung metastasis appeared later. TDT of metastatic tumor was 17 days. The metastasis was thought to have occurred when induction chemotherapy was performed.
It seems to be important to know the onset time of distant metastasis in order to determine the optimum time for chemotherapy in cases with oral cancer. Although no valid conclusions could be drawn because of the small number of patients studied here, we are going to conduct further studies.

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