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proportion of 14.7% is not ignorable. Many authors have published that the overall OCM was 13.7% to 42.9% according to T1 stage in MSCC. In a retrospective cohort study of 62 patients, Yang et al. showed that OCM of MSCC in tumor stages T2 to T4 occurred in 20% to 40% of patients, in whom END is recommended for management. Postoperative radiotherapy can improve the prognosis and decrease the recurrence of squamous cell carcinoma (SCC) after the first premolar plane area. Secondly, the authors demonstrated that the five-year overall survival rate (SR) was 51.9% for the END group and 74.0% for the non-END group, and the SR of treatment for regional recurrence was high at 71.4% in the five patients who were treated successfully. However, among the 12 patients with local recurrence, treatment for recurrence was successful for only four patients (33.3%). Two patients with locoregional recurrence died of uncontrolled disease; thus, the success rate of recurrence treatment was 0%. Hence, local control of the primary tumor is more important than the modality of neck management for survival of cN0 patients. When early detection of regional recurrence is possible, observation of cN0 neck is the choice irrespective of the site or T stage of MSCC. Based on these findings, the authors analyzed the management of cN0 MSCC patients on a “watch and wait” basis due to its low metastasis rate and likelihood of successful management of locoregional recurrence. Most information about OCM in MSCC patients has been published since 2010. Some results indicate that the metastatic risk is much higher than the expected risk in oral squamous cell carcinoma (OSCC), and END should be recommended for these patients. However, these issues must be approached cautiously, as treatment protocols are still controversial. Most of the studies are retrospective, with relatively small sample sizes; studies with high levels of evidence, such as prospective studies and clinical trials, are lacking. The development We read with interest, in the online issue of Journal of the Korean Association of Oral and Maxillofacial Surgeons, the recently published, original article by Park et al. titled “Is elective neck dissection needed in squamous cell carcinoma of maxilla?” This article was well written and provided a great deal of information regarding the incidence of occult cervical metastasis (OCM) of clinically node-negative neck (cN0) in maxillary squamous cell carcinoma (MSCC). However, we would like to suggest a few additional items based on the authors’ clinical experiences and recently updated articles. In their article, Park et al. concluded that the incidence of OCM of MSCC was not high enough to recommend elective neck dissection (END). For survival of cN0 patients, local control of the primary tumor is more important than the modality of neck management. Observation of cN0 neck is recommended when early detection of regional recurrence is possible, irrespective of the site or T stage. This article was well written and provided a great deal of information for the management of cN0 MSCC patients; however, we have some comments based on recent reviews. Four main commentaries regarding the main cN0 management in MSCC patients should be considered for the more careful and accurate management of these patients. First, Park et al. concluded that the incidence of OCM in MSCC is not high enough to recommend END, showing an incidence of 14.9% (10/67). However, an arithmetic BRIEF COMMUNICATION

journal of the korean association of oral and maxillofacial surgeons/journal of the korean association of oral and maxillofacial surgeon/daehan gu'gang ag'anmyeon oe'gwa haghoeji

Importance of elective neck dissection in cN0 maxillary squamous cell carcinoma