Conclusion
This meta-analysis estimated a pooled rate of occult lymph node metastases of 11% (99% CI: 0.07-0.17), with specific rates of 12% for pT3 tumours and 14% of pT4 tumours. Taking into account other pertinent factors such as the aim of single modality of treatment, the need to access the neck for reconstructive purposes, and the low morbidity for highly selective neck dissections, we would advocate that a selective neck dissection of at least level II should be considered in locally advanced (T3 and T4) TBSCC or radiotherapy to the upper neck.