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Cervical lymph nodes
Cervical lymph nodes
are lymph nodes found in the neck. Of the 800 lymph nodes in the human body, 300 are in the neck.[1] Cervical lymph nodes are subject to a number of different pathological conditions including tumours, infection and inflammation.[2]

Contents

1 Structure 2 Clinical significance 3 History 4 Additional images 5 References 6 External links

Structure[edit] 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.[3] One system divides the nodes as follows:[4][5]

Level I: Submental and submandibular nodes

Level Ia: Submental - found between the anterior belly of the digastric muscles Level Ib: Submandibular triangle
Submandibular triangle
- found around submandibular glands in submandibular space

Level II: Upper jugular nodes
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
Middle jugular nodes
- between the hyoid bone and cricoid cartilage Level IV: Lower jugular nodes
Lower jugular nodes
- between the cricoid cartilage and the clavicle Level V: Posterior cervical
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

Clinical significance[edit] Infectious mononucleosis
Infectious mononucleosis
(glandular fever) affects the cervical lymph nodes which become swollen. The characterization of cancerous lymph nodes on CT scan, MRI
MRI
or ultrasound is difficult, and usually requires confirmation by other nuclear imaging techniques such as PET scans. Tissue diagnosis by fine needle aspiration (which has a high rate of accuracy), may also be required. Cervical lymph node metastasis is a common feature of papillary thyroid carcinoma[6][7] History[edit] Henri Rouvière produced an influential classification in 1938.[8] 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.[9] Additional images[edit]

Superficial lymph glands and lymphatic vessels of head and neck.

Lymphatics of pharynx.

The lymphatics of the face.

References[edit]

^ a b "I. Classification". Retrieved 2008-02-16.  ^ Eisenmenger, LB; Wiggins RH, 3rd (January 2015). "Imaging of head and neck lymph nodes". Radiologic clinics of North America. 53 (1): 115–32. doi:10.1016/j.rcl.2014.09.011. PMID 25476176.  ^ Som PM, Curtin HD, Mancuso AA (1999). "An imaging-based classification for the cervical nodes designed as an adjunct to recent clinically based nodal classifications". Arch. Otolaryngol. Head Neck Surg. 125 (4): 388–96. doi:10.1001/archotol.125.4.388. PMID 10208676. [permanent dead link] ^ " Neck
Neck
Dissection". Archived from the original on 2008-02-20. Retrieved 2008-02-16.  ^ archotol.ama-assn.org ^ Chen, C. C.; Lin, J. C.; Chen, K. W. (2015). " Lymph node
Lymph node
ratio as a prognostic factor in head and neck cancer patients". Radiation Oncology. 10: 181. doi:10.1186/s13014-015-0490-9. PMC 4554293 . PMID 26302761.  ^ Park, C. H.; Song, C. M.; Ji, Y. B.; Pyo, J. Y.; Yi, K. J.; Song, Y. S.; Park, Y. W.; Tae, K (2015). "Significance of the Extracapsular Spread of Metastatic Lymph Nodes in Papillary Thyroid Carcinoma". Clinical and Experimental Otorhinolaryngology. 8 (3): 289–94. doi:10.3342/ceo.2015.8.3.289. PMC 4553362 . PMID 26330926.  ^ Rouvière H. Lymphatic system
Lymphatic system
of the head and neck. Tobias M, Translator. Ann Arbor, MI: Edwards Brothers, 1938. ^ Chong V (2004). "Cervical lymphadenopathy: what radiologists need to know". Cancer
Cancer
Imaging. 4 (2): 116–20. doi:10.1102/1470-7330.2004.0020. PMC 1434593 . PMID 18250018. 

External links[edit]

MedEd at Loyola medicine/pulmonar/PD/pstep23.htm http://www.patient.co.uk/showdoc/27000835/ anatomy of the cervical lymphatics

v t e

Anatomy of the lymphatic system

Head and neck

Head

Back

Occipital Mastoid/retroauricular Parotid

Superficial Deep

preauricular infra-auricular intraglandular

Front

Facial

buccinator nasolabial

Mandibular

Submandibular

Submental

Cervical

Superficial

anterior lateral

Deep

Deep anterior cervical

pretracheal paratracheal prelaryngeal thyroid

Deep lateral cervical

superior deep cervical inferior deep cervical retropharyngeal jugulodigastric jugulo-omohyoid

Other

Anterior cervical Lateral cervical Supraclavicular

Vessels

Jugular trunk

Arm and axilla

Nodes

Axillary

Brachial Pectoral Subscapular Central Apical

Arm

Supratrochlear Deltopectoral

Vessels

Subclavian lymph trunk

Chest

Nodes

Parasternal Intercostal Superior diaphragmatic Trachea and bronchi

superior inferior bronchopulmonary paratracheal intrapulmonary

Vessels

Thoracic duct Right lymphatic duct Bronchomediastinal lymph trunk

Abdomen

Nodes

Paraaortic

Retroaortic Lateral aortic Preaortic (Celiac

gastric hepatic splenic

Superior mesenteric

mesenteric ileocolic mesocolic

Inferior mesenteric

pararectal)

Other

Iliac

Common

external internal

Sacral

Retroperitoneal lymph nodes

Vessels

Lumbar lymph trunk Intestinal trunk Cisterna chyli

Leg

Inguinal

deep

Cloquet's node

superfici

.