Indications for neck dissection or irradiation in submandibular gland cancers

Clinically/radiologically N+ neck: Modified radical neck dissection (Levels I-V)

Clinically/radiologically N0 neck
- Elective treatment of the neck (Levels Ia,b, IIa and III )
- Elective neck dissection and elective radiotherapy are equally effective
- Known risk factors for occult neck disease are
  - Tumour size >4cm
  - High-grade histology
  - Extraglandular tumour extension
- With a clinically or cytologically malignant tumour, electively clear all nodes in Level I to avoid having to redissect Level I
  - If positive on frozen section, proceed to modified neck dissection
  - If frozen section not available, then histology of lymph nodes guides subsequent treatment