Tailoring Neck Management in Oral Cavity Squamous Cell Carcinoma: A Scoping Review

Background and Objectives: Management of cervical lymph nodes is a key feature of oral cavity squamous cell carcinoma (OCSCC) treatment, but uncertainty remains regarding indications, extent, and laterality of neck surgery. This scoping review aimed to synthesize the available evidence on surgical neck management in OCSCC. Materials andMethods: A scoping review was conducted according to PRISMA-ScR recommendations. PubMed/MEDLINE, Embase, Scopus, and Cochrane were searched for original studies addressing cervical nodal management in adult patients with OCSCC. Findings were synthesized descriptively. Results: Eighty-five studies were included. In clinically node-negative disease, depth of invasion was the most frequently investigated predictor of occult nodal metastasis, while additional clinicopathological factors and multiparametric models may contribute to risk stratification, although some are available only after surgical resection. Randomized evidence supported elective neck dissection (END) over observation, while sentinel lymph node biopsy (SLNB) represented an alternative staging strategy in selected patients with early-stage disease. Occult metastases predominantly involved levels I–III, whereas isolated involvement of level IIb and the lower neck was uncommon. Contralateral nodal risk was associated with midline proximity, tumor subsite and extent, and ipsilateral nodal burden. In clinically node-positive disease, evidence regarding the extent and laterality of neck dissection was heterogeneous and predominantly retrospective. Conclusions: Neck management in OCSCC should be individualized according to clinical nodal status, tumor characteristics, and patterns of lymphatic spread. This scoping review maps the available evidence and highlights existing knowledge gaps, while acknowledging that the oncological safety of surgical de-escalation remains to be established. Further prospective studies are warranted to validate individualized surgical strategies.