8
Treatment
Figure 2. Treatment Algorithm for Management of The Neck
In Patients with Oropharyngeal Squamous Cell
Carcinoma of the Head and Neck
The multidisciplinary team should
discuss with patients the potential
functional impact of bilateral neck
dissection and post-operative
adjuvant radiation therapy with
or without chemotherapy
Adequate dissection
should include
at least 18 lymph
nodes
Patients with tumors extending to the
midline tongue-base or palate or involving
the posterior oropharyngeal wall
Patients with lateralized
oropharyngeal cancer
who have neck dissection
concurrently or before
transoral endoscopic
head and neck surgery
should have ligation of
at-risk feeding blood
vessels to reduce the
severity and incidence of
post-operative bleeding
Patients with
lateralized patients
oropharyngeal
carcinoma who
are being treated
with upfront
curative surgery
Patients with
lateralized patients
with cN+ disease
who have either
unequivocal
extranodal
extension into
surrounding soft
tissues or carotid
artery or cranial
nerve involvement
Bilateral neck
dissections unless
bilateral adjuvant
radiotherapy is planned
Ipsilateral neck
dissection of
levels II-IV
Non-surgical
approach
Patients with biopsy-proven
distant metastases should not
undergo routine surgical resection
of metastatic cervical lymph nodes
