AIM:The treatment of salivary gland cancers with clinically negative neck is controversial, with divergent guidelines about elective neck dissection (END). Even though these guidelines are widely used, they mostly rely on retrospective research that are subject to methodological flaws and selection bias. METHODS:A critical narrative review. Problem description, identification of likely clinical scenarios, appraisal of previous recommendations, critical examination of available data, and presentation of clinical decision-making options comprised the article creation. RESULTS:One of the most important factors is the rate of occult lymph node metastases, which ranges from 2-30% and varies greatly depending on the kind and grade of tumor. The use of risk classification according to preoperative findings, such as tumor size, grade, and clinical signs such involvement of the facial nerve, offers some guidance. Nevertheless, unanticipated cancers are frequently discovered by intraoperative and postoperative histological results, which makes decision-making even more difficult. Alternatives to END, including elective neck irradiation, have similar effectiveness in reducing regional recurrence in high-risk scenarios. Although END may enhance regional control, it carries risks of surgical complications, such as injury to nerves and functional impairment. No prospective randomized studies have definitively demonstrated the advantage of END regarding survival or recurrence. CONCLUSION:END may be appropriate in certain high-risk situations, but its regular use in cN0 salivary gland cancers is still up for debate. A personalized strategy that accounts for tumor-specific and patient-related variables, together with careful use of adjuvant treatments, is advised until substantial prospective data is available.

Objective: To verify the prevalence of cervical lymph node metastasis in adenoid cystic carcinoma of major salivary glands, and to establish recommendations for elective neck treatment.Methods: A search was conducted of the US National Library of Medicine database. Appropriate articles were selected from the abstracts, and the original publications were obtained to extract data.Results: Among 483 cases of major salivary gland adenoid cystic carcinoma, a total of 90 (18.6 per cent) had cervical metastasis. The prevalence of positive nodes from adenoid cystic carcinoma was 14.5 per cent for parotid gland, 22.5 per cent for submandibular gland and 24.7 per cent for sublingual gland. Cervical lymph node metastasis occurred more frequently in patients with primary tumour stage T3-4 adenoid cystic carcinoma, and was usually located in levels II and III in the neck.Conclusion: Adenoid cystic carcinoma of the major salivary glands is associated with a significant prevalence of cervical node metastasis, and elective neck treatment is indicated for T-3 and T-4 primary tumours, as well as tumours with other histological risk factors.

Objective: To review reports of adenoid cystic carcinomas arising in the head and neck area outside of the major salivary glands, in order to enhance the care of patients with these unusual neoplasms.Methods: An international team of head and neck surgeons, pathologists, oncologists and radiation oncologists was assembled to explore the published experience and their own working experience of the diagnosis and treatment of adenoid cystic carcinomas arising in the vicinity of the sinonasal tract, nasopharynx, lacrimal glands and external auditory canal.Results: The behaviour of adenoid cystic carcinoma arising in head and neck sites exclusive of the major salivary glands parallels that of tumours with a similar histology arising in the major salivary glands-these are relentless, progressive tumours, associated with high rates of mortality. Of 774 patients reviewed, at least 41 (5.3 per cent) developed documented regional node metastases.Conclusion: The relatively low overall incidence of nodal metastases in adenoid cystic carcinomas arising in the head and neck region outside of the major salivary glands suggests that routine elective regional lymph node dissection might not be indicated in most patients with these tumours.

Background: Trismus indicates severely restricted mouth opening of any aetiology. A mouth opening of 35 mm or less should be regarded as trismus. Aim of this study was to review the etiopathogenesis, incidence, treatment and prevention of trismus in patients with head and neck cancer.Objective of review: Trismus is frequently seen in patients suffering from malignant tumours of the head and neck. The reported prevalence of trismus in those patients varies considerably in the literature and ranges from 0 to 100% depending on the tumour site and extension. Trismus may worsen or remain the same over time, or the symptoms may reduce, even in the absence of treatment. When a patient presents with trismus after tumour treatment, it is important to determine whether the trismus is the result of the treatment, or is the first sign of a recurrence. Restricted mouth opening may impede inspection of the oral cavity as needed for dental care, and particularly for oncologic follow-up.Conclusions: Mouth opening after radiotherapy (RT) decreases on average by approximately 20% compared to mouth opening prior to RT. The prevalence of trismus increases with increasing doses of RT to mastication structures. The use of intensity-modulated RT seems to lower the percentage and severity of RT-induced trismus. Treatment of trismus can be conservative (with either medical or physical therapy) or surgical. Exercise therapy is the mainstay of treatment and exercise should start as soon as possible after treatment. The prevention of trismus, rather than its treatment, is the most important objective.