Study On The Feasibility Of Preserving The Submandibular Gland In The Neck Dissection Of Oral Cancer

Objectives:The distribution of lymph nodes in the submandibular gland and lymph nodes around the submandibular gland was analyzed by histopathology,reasons for submandibular gland resection ,the rule of lymph node metastasis in patients with oral cancer and pathological features of resection of submandibular gland and its duct in patients with oral cancer.To investigate the feasibility of preserving submandibular gland in oral cancer patients with oral cancerMethods: (1)From October 2015 to September 2016, 137 cases that submandibular gland resection in the Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Kunming Medical University, were studied .137 patients were observed during operation,complete separation of lymph gland from submandibular gland and submandibular triangle,the anatomical location of the lymph nodes were recorded.Histological examination of the submandibular gland was performed to detect the presence of an internal lymph node,and pathological examination results of primary were regarded as reasons for submandibular gland resection .(2)A retrospective analysis of 82 patients with oral cancer. Objective to analyze the pathological characteristics and influencing factors of submandibular gland, and to explore the rule of lymph node metastasis.(3)Prospective study of 56 patients with oral cancer,from February 2016 to April 2017.54 patients with oral cancer were observed during the operation,the lymph nodes,submandibular gland and the submandibular duct were separated.Pathological examination of submandibular gland and submandibular duct by frozen section during the operation.Histopathological examination to determine the existence of malignant tumor cells and inflammatory cells in 'submandibular gland, the existence of malignant tumor cells of submandibular gland duct tumor cells in adjacent tissue,whether intravascular thrombus formation, whether malignant tumor cells in lymph nodes. The data were analyzed according to the results of disease detection.Results:(1)The primary disease of submandibular gland is the main reason for the removal of submandibular gland, submandibular gland inflammatory lesions and submandibular duct stones are the most common diseases in the submandibular gland;(2)In all cases, the lymph nodes in submandibular gland were not found. The occurrence rate of lymph nodes and the average number of lymph nodes in submandibular gland of benign and malignant tumors were statistically significant.(3)Excision of submandibular gland in neck dissectionis mainly normal submandibular gland, there were submandibular gland with chronic inflammation or inflammatory cell infiltration in each of the 56 sides, accounting for about 37.6%,while the submandibular gland showed an age-related change of about 4.7% cases. 1 cases of highly differentiated squamous cell carcinoma (T4aT2bM0) in the left side of the mouth directly invade the submandibular gland through the invasion of the oral floor. The results showed that the incidence rate of inflammatory cell infiltration in submandibular gland was higher in patients with advanced age and primary exposure to direct contact with the outside world. There was no significant correlation between gender, tumor T stage and cervical lymph node metastasis.(4)Histopathological examination of :there are 2 cases ware find tumor thrombi in Wharton duct,cancer cells did not invade Wharton ductConclusion: Oral cancer metastasis to the submandibular lymph nodes is relatively common, but the transfer to the submandibular gland is rare.Therefore, the preservation of submandibular gland in the oral cancer neck dissection is safe in the histopathology level.The primary focus for oral cancer which is far away from the submandibular gland.Preservation of submandibular gland in neck dissection may be feasible and simultaneous submandibular gland transfer.Protection of submandibular gland during radiotherapy.Patients with submandibular gland preservation, After surgery should be at least 2-3 years of follow-up,if the recurrence or metastasis were found to be re operation.However, there is a lack of randomized controlled trials in this study, and there is insufficient evidence to retain the submandibular gland.Operative plan should be carefully chosen by surgeons.