Sublingual Compartment Resection for the Management of Squamous Cell Carcinoma of the Oral Tongue and Floor of Mouth: A Single Surgical Team's Experience

Purpose: Lingual lymph node (LLN) metastases have been identified in the resection specimens of squamous cell carcinoma (SCC) of the oral tongue and floor of mouth. They lie above the mylohyoid muscle, and they are excluded from the extent of a discontinuity neck dissection. The purpose of this study was to determine the frequency of LLN in a series of resection specimens of SCC of tongue-floor of mouth, and discuss its relevance to the philosophy of compartment tongue-floor of mouth resection. Methods: The authors undertook a retrospective cohort study of the pathology records of 181 patients who underwent wide local excision of the tongue and floor of mouth compartment, in combination with an appropriate neck dissection and free flap reconstruction for SCC. A descriptive analysis was undertaken of those patients who were identified as harbouring LLN in their resection specimen. Results: We identified that 7.73% (n = 14) of the study cohort harboured LLN. There were eight males and six females. Their average age was 61.85 (range: 56-72). The average depth of tumour invasion was 11.02mm (range: 1-20). (n = 12 patients with tumor depth of invasion at least greater than 5 mm) Three patients had positive LLN (1.65% of total cohort and 21.4% of LLN cohort); one median, and two lateral. Conclusions: LLN (first echelon nodes) can potentially allow for either the local uptake or direct passage of tumour emboli into the cervical lymph node. Their presence in SCC of tongue-floor of mouth may portend a poor prognostic outlook if they are not resected at the time of primary surgery. Our study lends further support to the argument that the surgical management of SCC of tongue-floor of mouth should include a sublingual compartment resection in combination with an appropriate neck dissection.