FACIAL NODE INVOLVEMENT IN HEAD AND NECK CANCER

Background. Facial node involvement in head and neck cancer is rarely documented. Furthermore, facial node re- moval may increase the risk of damage to the marginal mandi- bular nerve. Thus, although they may receive afferent lymphatic drainage from the oral cavity, facial nodes are rarely removed during neck dissection. Methods. We retrospectively reviewed the records of 29 patients with oral cavity or oropharyngeal carcinomas who underwent facial node sampling in 32 heminecks during neck dissection for oral cavity or oropharyngeal cancer. Results. Facial node metastases were present in seven pa- tients. Facial node involvement was much more common among patients with palpable cervical lymphadenopathy. Positive facial nodes were associated with an increased risk of treatment failure and a poorer survival. Conclusions. In patients with oral cavity/oropharyngeal pri- mary tumors and palpable cervical lymphadenopathy, consid- eration should be given to removal of facial nodes during neck dissection; however, further data are awaited before any benefits can be quantified. A 2004 Wiley Periodicals, Inc. Head Neck 26: 531-536, 2004 The lymph nodes of the face are found along the course of the branches of the facial vessels in the subcutaneous tissues of the face. They have been classified by Rouviere into four groups: malar (su- perficial to the malar eminence just lateral to the eye); infraorbital (in the canine fossa or nasolabial fold); buccinator (overlying thebuccinator muscle); and mandibular (along the outer surface of the mandible, adjacenttothefacial artery). 1 Aswell as receiving afferent drainage from the skin and subcutaneous tissues of the face, these nodes also receive some drainage from the gingival and buccal mucosae. 2 The efferent drainage is primar- ily to submandibular lymph nodes. The facial nodes may occasionally be involved with cancer of the head and neck; however, this is rare- ly documented. 3,4