Contemporary management of the clinically N0 neck in oral squamous cell carcinoma.

[BACKGROUND] The management of the clinically negative neck (N0) in oral squamous cell carcinoma (OSCC) remains a challenging clinical dilemma. Although imaging techniques have advanced, occult metastases are present in approximately 20-30% of patients with early-stage oral cancer and clinically negative necks.

[OBJECTIVE] This review examines current evidence on optimal strategies for managing the N0 neck in oral cancer patients.

[METHODS] We discuss diagnostic modalities for detecting occult metastases, including clinical examination, conventional imaging (ultrasonography, computed tomography, magnetic resonance imaging), functional imaging (positron emission tomography), and sentinel lymph node biopsy. The review evaluates the main management approaches---elective neck dissection, watchful waiting, and sentinel lymph node biopsy---analyzing current evidence from randomized controlled trials and meta-analyses.

[RESULTS] We examine patient and tumor factors that influence decision-making, including tumor thickness, location, differentiation, and pattern of invasion. Special considerations for specific subsites and clinical scenarios are discussed.

[CONCLUSIONS] Finally, we explore emerging technologies and future directions in the management of the N0 neck, including molecular biomarkers, liquid biopsy techniques, and personalized approaches to treatment. This review provides evidence-based recommendations to support clinical decision-making for managing patients with oral cancer and clinically negative necks.