Histopathologic study of the carotid sheath in patients with oral squamous cell carcinoma

Purpose: The carotid sheath has not been adequately assessed in the literature as a potential site of neck recurrence. The purpose of this prospective study was to investigate the histopathologic characteristics of the carotid sheath in patients with oral cancer, in an effort to clarify whether it is essential or redundant to include the carotid sheath in the neck dissection specimen.

Patients and methods: A total of 29 patients underwent 32 selective neck dissections in the Department of Oral and Maxillofacial Surgery at "Evangelismos" General Hospital of Athens, Greece. Twenty-six unilateral and 3 bilateral neck dissections were performed. The carotid sheath specimens were examined to identify possible traces of metastatic disease. The existence of lymphatic vessels and the possible presence of cancer cells within their lumen was also investigated.

Results: Light microscopy of the 32 carotid sheath specimens showed that there was no evidence of tumor invasion. Immunohistochemical evaluation showed an abundance of lymphatic vessels in the carotid sheath with no evidence of microscopic intraluminal metastatic emboli.

Conclusions: There was no evidence of carotid sheath invasion or presence of intraluminal lymphatic tumor emboli. Evidence of extracapsular spread warrants carotid sheath excision. Our findings suggest that if no extracapsular spread is present, there is no need to perform a tedious dissection of the carotid sheath. Preserving the carotid sheath adds protection to the neurovascular bundle, cuts operating time, and avoids possible injury to the major vessels and vagus nerve, as well as stimulation of the carotid body.