Because laryngeal squamous cell carcinoma (LSCC) rarely metastasizes to level IIb lymph nodes, that area can generally be preserved during neck dissection to avoid damaging the function of the spinal accessory nerve, which runs through that region.

Investigators reached this conclusion during a recent study of 81 patients diagnosed with LSCC, in which level IIb nodal metastasis was seen in just 5 participants (6%). The relationship between level IIb metastasis and clinical N stage was not statistically significant, with 2 of the 5 patients being classified as clinically N+ and 3 patients classified as N-. Similarly, no statistically significant relationships between level IIb involvement and primary tumor site, central tumor presence, or T stage were found.  

The spinal accessory nerve, which is located on the side of the neck, helps control specific shoulder movements. Preservation of the nerve helps prevent postoperative pain and limitations to shoulder function in persons undergoing neck dissection. With these study results indicating that level IIb nodal involvement is very rare in LSCC, “The area can generally be preserved in elective neck dissection to lessen morbidity and, specifically, to avoid damaging the function of the spinal accessory nerve,” wrote the researchers (Otolaryngol Head Neck Surg. 2012;146[3]:390-394).

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