Patterns of Lymph Node Metastasis in Buccal Carcinoma

Abstract

Buccal carcinoma appears to be the most frequent malignant neoplasm of the oral cavity in South Asia, particularly in Bangladesh, because of widespread consumption of tobacco and betel nut. Lymph node metastasis is an important factor for prognosis, staging and planning of treatment in buccal carcinoma. A cross-sectional, descriptive study was conducted in the Department of ENT and Head-Neck Surgery, in collaboration with the Department of Pathology, Dhaka Medical College Hospital, Bangladesh, to evaluate the pattern, rate and distribution of metastasized lymph nodes in patients with buccal carcinoma. Between January 2023 and December 2024, a total of 57 histopathologically proven cases of buccal carcinoma were included in the study. Nodal involvement was determined using clinical examination, radiological review and histopathological evidence. The mean age of the patients was 53.7±9.6 years and male-female ratio was 3:1. Out of 57 patients, 35(61.4%) had histopathologically confirmed lymph node metastasis, while 22(38.6%) showed no nodal involvement. Among those with metastasis, unilateral cervical lymph node involvement was most frequent (52.6%), while bilateral metastasis was found in 8.8% of patients. Level I (submandibular) lymph nodes were the most commonly affected, observed in 40.3% of patients, followed by Level II (upper deep cervical) nodes in 29.8%. Involvement of Level III nodes was seen in 15.7%, and only a few patients showed metastasis to Levels IV and V (7% and 3%, respectively). 15 out of 20 Stage III patients (75%) and 14 of 17 Stage IV patients (82.3%) had nodal metastasis, whereas only 6 of 20 patients (30%) in Stage II exhibited nodal spread. Poorly differentiated carcinomas showed the highest incidence of nodal involvement (77%) compared to moderately (54%) and well-differentiated tumors (29%).  

CBMJ 2026 July: Vol. 15 No. 02 P:21-26