Extent of neck dissection after transoral robotic surgical resection of oropharyngeal squamous cell carcinoma: Report of a case and potential indications for inclusion of level I in a selective neck dissection

Background With new minimally invasive surgical techniques playing a role in the management of early oropharyngeal carcinomas, appropriate surgical management of the neck is an increasingly important consideration. Methods. We present a case of a 47-year-old patient with a clinical T2N1M0 squamous cell carcinoma (SCC) of the right tonsil with anterior extension toward the floor of the mouth from the right glossotonsillar sulcus. Imaging revealed a solitary necrotic lymph node in level IIA. The decision was made to proceed with a transoral robotic pharyngectomy and selective neck dissection of levels II to IV, followed by adjuvant radiotherapy. Results. A postoperative scan revealed progressive regional disease in the anterior aspect of level IB, and, as such, a completion neck dissection of level I was performed. Conclusion. Special consideration must be given to level I, particularly in patients with glossotonsillar sulcus involvement and anterior extension toward the floor of the mouth. (C) 2015 Wiley Periodicals, Inc.