Cervical lymph nodes
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| Cervical lymph nodes | |
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Regional lymph tissue. (Cervical near top, in green.)⋅
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| File:Illu lymph chain02.jpg
Deep Lymph Nodes
1. Submental 2. Submandibular (Submaxillary) Anterior Cervical Lymph Nodes (Deep) 3. Prelaryngeal 4. Thyroid 5. Pretracheal 6. Paratracheal Deep Cervical Lymph Nodes 7. Lateral jugular 8. Anterior jugular 9. Jugulodigastric Inferior Deep Cervical Lymph Nodes 10. Juguloomohyoid 11. Supraclavicular (scalene) |
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| Details | |
| Latin | Nodi lymphoidei cervicales |
| Identifiers | |
| TA | Lua error in Module:Wikidata at line 744: attempt to index field 'wikibase' (a nil value). |
| TH | {{#property:P1694}} |
| TE | {{#property:P1693}} |
| FMA | {{#property:P1402}} |
| Anatomical terminology
[[[d:Lua error in Module:Wikidata at line 863: attempt to index field 'wikibase' (a nil value).|edit on Wikidata]]]
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Cervical lymph nodes are lymph nodes found in the neck.
Contents
Structure
There are approximately 300 lymph nodes in the neck, and they can be classified in many different ways.[1]
Commonly used systems have been devised by the American Academy of Otolaryngology and the American Joint Committee on Cancer.[2]
One system divides the nodes as follows:[3][4]
- Level I: Submental and submandibular nodes
- Level Ia: Submental - found between the anterior belly of the digastric muscles
- Level Ib: Submandibular triangle - found around submandibular glands in submandibular space
- Level II: Upper jugular nodes - Between posterior belly of digastric muscles superiorly and hyoid bone inferiorly
- Level IIa: Anterior, medial, lateral or posterior to internal jugular vein, or if posterior, must not have an intervening fat plane
- Level IIb: Posterior to internal jugular vein with fat plane between nodes and internal jugular vein
- Level III: Middle jugular nodes - between the hyoid bone and cricoid cartilage
- Level IV: Lower jugular nodes - between the cricoid cartilage and the clavicle
- Level V: Posterior cervical or spinal accessory nodes, posterior to the sternocleidomastoid muscle
- Level VA: Spinal accessory nodes from skull base to bottom of cricoid cartilage
- Level VB: Spinal accessory nodes between cricoid and clavicle
- Level VI: Visceral space lymph nodes - midline group of cervical nodes from hyoid to sternal manubrium, includes prelaryngeal, pretracheal, and paratracheal subgroups
- Level VII: Superior mediastinal nodes - between carotid arteries from top of manubrium superiorly to innominate vein inferiorly
Features of malignancy
The characterization of neoplastic lymph nodes on CT, MRI or ultrasound is difficult, and usually requires confirmation by further imaging such as PET scans, and ultimately tissue diagnosis by fine needle aspiration, core biopsy, or surgical excision. Indirect features have been extensively researched however, including a ratio of long:short axis of less than 2 (subjectively round as opposed to oval shape),[5] loss of the fatty hilum, necrosis, ill defined margin (implying extra capsular spread), peripherally increased flow on Doppler ultrasound, punctate calcifications in patients with primary papillary thyroid cancer and a reticulated appearance in patients with lymphoma.[6]
History
Henri Rouvière produced an influential classification in 1938.[7] However, this system was based upon anatomical landmarks found in dissection, making it imperfectly suited to the needs of clinicians, which led to new terminology for the lymph nodes that could be palpated.
More recently, classification systems have been proposed organized around what can be observed via diagnostic imaging.[8]
Additional images
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Superficial lymph glands and lymphatic vessels of head and neck.
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Gray603.png
Lymphatics of pharynx.
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Gray604.png
The lymphatics of the face.
References
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- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ archotol.ama-assn.org
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Rouvière H. Lymphatic system of the head and neck. Tobias M, Translator. Ann Arbor, MI: Edwards Brothers, 1938.
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
