Oral cavity and oropharynx squamous cell carcinoma with metastasis to the parotid lymph nodes

Abstract

To increase awareness of the potential of oral and oropharyngeal squamous cell carcinoma (SCC) to metastasize to the parotid region. We retrospectively reviewed patients who had undergone parotidectomy for metastatic oral or oropharyngeal SCC at a single tertiary care facility from January 1988 to January 2004. Exclusion criteria were a history of cutaneous SCC of head and neck or extension of primary tumor into the parotid gland. Twelve patients met study criteria. Parotid metastasis represented the initial disease manifestation in 4 cases. In 1 case, parotid metastasis presented synchronously with the primary tumor. Parotid metastasis represented recurrent disease in the other 7 cases. Primary subsites included tongue base (n=4), tonsil (n=3), lateral pharyngeal wall (n=2), oral floor (n=1), maxillary alveolus (n=1), and retromolar trigone (n=1). Pathologic findings showed grade 3 or 4 SCC in all patients. Parotid metastasis was located in the inferior parotid nodes in 7 cases; multiple superficial nodes, 3 cases; and both deep and superficial nodes, 2 cases. Oral and oropharyngeal SCC can metastasize to the intraparotid lymph nodes. The inferior parotid nodes are most commonly involved, and patients generally have substantial associated cervical metastases. When treating patients who have oral or oropharyngeal cancer with substantial cervical metastasis, physicians should consider removing the inferior parotid lymph nodes. We recommend that when intraparotid lymph node metastasis is detected, total parotidectomy and multidisciplinary adjuvant therapy should be conducted.