Occult Metastasis in T2 Lesions of Oral Squamous Cell Carcinoma Involving the Lower Alveolar Ridge and Vestibule Among Snuff Dippers: A Cross-Sectional Study

Background: Oral Squamous Cell Carcinoma (OSCC) is a common malignancy in South Asia, with snuff dipping identified as a major risk factor. Even in the absence of clinically palpable lymph nodes, occult cervical metastasis in T2 OSCC lesions poses a significant threat to prognosis and treatment outcomes. Objective: To determine the frequency of occult cervical lymph node metastasis in T2 OSCC lesions of the lower alveolar ridge and vestibule among snuff users. Methodology: This cross-sectional descriptive study was conducted at the Department of Maxillofacial Surgery, Mardan Medical Complex, from February to August 2024. A total of 323 patients aged 40–70 years, clinically node-negative (N0), with T2 OSCC of the lower alveolar ridge or vestibule were enrolled through non-probability consecutive sampling. Inclusion criteria included Pakistani nationals, habitual snuff users, and no prior surgical or radiotherapy intervention. Demographic and clinical data were recorded. Occult metastasis was assessed through sentinel lymph node biopsy and confirmed via histopathology. Results: The mean age was 50.6 ± 7.55 years, with males comprising 82% (n = 265) of participants. Tumor grading revealed G4 in 34.7%, G1 in 31.3%, G2 in 20.7%, and G3 in 13.3% of patients. Occult metastasis was detected in 140 patients (43.3%). No statistically significant association was observed between occult metastasis and age or gender (p > 0.05). Conclusion: A high frequency of occult metastasis was observed among clinically node-negative T2 OSCC patients with a history of snuff use. These findings underscore the need for early detection, consideration of elective neck dissection, and aggressive treatment planning, even in the absence of clinically evident nodal disease, particularly in high-risk populations. Keywords: Lymphatic Metastasis, Mouth Neoplasms, Neoplasm Staging, Squamous Cell Carcinoma of Head and Neck, Smokeless Tobacco.