Is an Elective Neck Dissection Needed in Squamous Cell Carcinoma of the Maxillary Alveolus and Hard Palate?

Background Squamous cell carcinoma (SCC) of the maxillary alveolus and hard palate is a rare site for oral cavity carcinoma. Much controversy is there regarding the management of this site and elective neck dissection due to rarity and complex lymphatic drainage. Objective To estimate the prevalence of neck nodal metastasis in squamous cell carcinoma of maxillary alveolus and hard palate and the factors influencing the nodal metastasis. Method This retrospective cohort study includes patients diagnosed with squamous cell carcinoma of maxillary alveolus and hard palate and who underwent surgical intervention between March 2017 and March 2022. Result The study included 53 patients among them majority were men (73.6%). Prevalence of neck nodal metastasis was 36.6% and occult nodal metastasis was noted in 16%. On multivariate analysis, clinical nodal positivity increases the odds of pathological nodal positivity by 9.4 times compared to no nodal involvement (95% CI 2.07-42.57, p < 0.004). A depth of invasion (DOI) of more than 10 mm increases risk by 7.4 times for pathological nodal positivity compared to less than 10 mm invasion (95% CI 1.53- 35.27, p=0.013). Conclusion Squamous cell carcinoma of maxillary alveolus and hard palate has a high risk of nodal metastasis. Depth of invasion is an important predictor for nodal metastasis. Due to the high risk of nodal metastasis elective neck dissection would be recommended in advanced stages. Squamous cell carcinoma of maxillary alveolus and hard palate with nodal metastasis has a poor survival.