Value of neck dissection in patients with cancer of the parotid gland and a clinical NO neck

Cervical lymph node metastases in patients with parotid gland carcinoma are not rare. Regional metastases have a significant influence on the prognosis of these patients. In spite of the clinical relevance of lymphogenous metastases, the indications for elective treatment of the neck are not well defined. In the present review the controversies and therapeutical strategies of ipsilateral neck lymph nodes and their extension in patients with potential occult lymph node metastases are discussed. On the basis of the published data, in consideration of the direction of lymphogenous metastatic spread of parotid gland carcinomas, an elective neck dissection is recommended in carcinomas with high percentage of lymphatic spread also in the N0 neck. Consideration of additional parameters (> T2, lymphangiosis carcinomatosa) is appropriate to perform also a neck dissection in carcinomas with low risk for lymphogenous metastases. An elective neck dissection should include levels I, II, III and upper V.