American Association of Oral and Maxillofacial Surgeons' position paper on the management of the clinically negative neck (cN0) in cT1N0 and cT2N0 oral squamous cell carcinoma

Authors

• Brent B. Ward, Chalmers J. Lyons Professor of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI; Professor of Dentistry, University of Michigan, Ann Arbor, MI; Professor of Surgery, University of Michigan, Ann Arbor, MI; Associate Program Director of the Oral/Head and Neck Oncology, University of Michigan, Ann Arbor, MI; Microvascular and Reconstructive Surgery Fellowship, University of Michigan, Ann Arbor, MI. Electronic address: bward@umich.edu.
• Deepak Kademani, Medical Director of Minnesota Oral and Facial Surgery, Minneapolis, MN; Fellowship Director, Head and Neck Oncologic and Reconstructive Surgery, Minneapolis, MN.
• Mohammed Qaisi, Advocate Health - MidwestFollow
• Raymond P. Shupak, Assistant Professor, Department of Oral and Maxillofacial Surgery, Geisinger Health System, Danville, PA.
• Eric R. Carlson, Assistant Professor, Department of Oral and Maxillofacial Surgery, Geisinger Health System, Danville, PA.

Recommended Citation

Ward BB, Kademani D, Qaisi M, Shupak RP, Carlson ER. American Association of Oral and Maxillofacial Surgeons' Position Paper on the Management of the Clinically Negative Neck (cN0) in cT1N0 and cT2N0 Oral Squamous Cell Carcinoma. J Oral Maxillofac Surg. Published online May 14, 2026. doi:10.1016/j.joms.2026.05.004

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Background: Management of the N0 neck is a challenging clinical decision. Most of the literature relied on for clinical decision-making are studies with subjects being treated for cT1/cT2 N0 disease.

Purpose: The purpose of this American Association of Oral and Maxillofacial Surgeons (AAOMS) position paper is to provide a narrative review that summarizes and synthesizes the current literature evidence and provides current treatment strategies for cT1 and cT2 N0 (not cT1/cT2 combined) patients, as well as identify knowledge gaps to suggest future research needs for this critical clinical question. For enhanced clarity and in contrast to other organizations, AAOMS suggests that these 2 patient groups be considered distinct from data, research, and clinical perspective to provide for treatment decisions at present and future research direction within the scientific community.

Methods: A comprehensive search of the literature related to treatment of the neck in oral cancer was completed using PubMed for articles published between January 1, 2000, and February 28, 2026. Keywords for the search included clinically negative neck, N0 neck in oral cancer, depth of invasion guided neck dissection, sentinel lymph node biopsy in squamous cell carcinoma of the oral cavity, cT1 oral cavity cancer, cT2 oral cavity cancer, and supraomohyoid neck dissection. The list of articles was then cross-referenced with position statement recommendations from the National Comprehensive Cancer Network, the American Society of Clinical Oncology, and the British Association of Head & Neck Oncologists. A working group of the AAOMS Committee on Head and Neck Oncologic and Reconstructive Surgery reviewed these findings and agreed to serve as authors.

Results: Sixty-two articles were included in the final review as were guideline recommendations from National Comprehensive Cancer Network, American Society of Clinical Oncology, and British Association of Head & Neck Oncologists. Literature regarding the treatment of cT1 and cT2 N0 patients is contaminated by the combining of these groups into single recommendations. Three accepted treatment options exist: elective neck dissection, sentinel node biopsy, and depth and site-guided elective neck dissection, each with advantages and disadvantages.

Conclusion and relevance: Best literature evidence and surgeon skillset should guide the recommendations of surgeons and treatment of patients when entering a shared decision-making model for treatment or observation of the neck in oral cancer. Recommendations made in this position paper can assist in the process of clinical decision-making and communication with patients. Treatment decisions and research moving forward should appreciate and attempt to fill current knowledge gaps by enhancing focus of cT1N0 and cT2N0 as distinct patient populations from a data and analysis perspective including in clinical trial design.

Type

Article

PubMed ID

42202880