Management of metastases to the lymph glands of the neck.

The survival rate of matched pairs of patients, one patient in each pair being submitted to prophylactic neck dissection, the other to a policy of "wait and see" has been measured: there was no significant difference in the survival rates of the two groups. Surgery for most patients with a gland in the neck gives better results than radiotherapy, and can produce satisfactory results with such procedures as supraglottic laryngectomy to epiglottic tumours and replacement with the deltopectoral flap for tonsillar tumours. On the other hand, surgery is probably contraindicated for patients with antral carcinoma and a gland in the neck, whom it rarely cures. Surgery does not increase the survival of patients with bilateral glands in the neck (except those with supraglottic tumours) and its contraindicated. Surgery can prolong the survival of patients with nodes fixed to the skin, the mandible or the external carotid artery, and may occassionally cure such patients.