Is extended selective supraomohyoid neck dissection indicated for treatment of oral cancer with clinically negative neck?

Oral cavity tumors may develop occult metastases to the cervical lymph nodes. Current imaging techniques and routine histopathologic methods may fail to detect lymph node micrometastases, but the surgeon has to electively dissect a neck at risk of developing clinical disease. Supraomohyoid neck dissection has been the elective surgery for treating a clinically negative neck in patients with oral cavity primaries. A Literature review revealed that level IV nodes can be significantly affected by occult disease with and without metastases in level I-III lymph nodes. This means that level IV nodes have to he included in the supraomohyoid neck dissection, resulting in a more extensive surgical procedure to ensure a margin of oncological safely.