Cervical nodal metastasis in head and neck cancer: a clinical conundrum

Within a month of being treated with a partial maxillectomy for a stage T2NM (staged as per preoperative MRI and CT) left maxillary antral carcinoma, a patient suffered symptoms of ‘sore throat’ and also tested positive for a streptococcal infection on a swab test. Though appropriate antibiotics relieved symptoms, a minimal dysphagia persisted which was conveniently attributed by the patient as ‘being related to the streptococcal infection’. However, after two months, the 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG-PET/CT) which was performed as part of a post-treatment follow-up, demonstrated multiple contralateral avid neck-nodes (levels II–IV). This was histopathologically confirmed to be harbouring metastatic deposits of squamous cell carcinoma (figure 1 …