Cervical lymph nodes

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Cervical lymph nodes
Lymph node regions.svg
Regional lymph tissue (Cervical near top, in blue)
Cervical lymph nodes and levels.png
Cervical lymph node levels (American Academy of Otolaryngology system from 2002 [1] [2] [3] ), and superficial nodes
Details
System Lymphatic system
Identifiers
Latin Nodi lymphoidei cervicales
Anatomical terminology
Deep Lymph Nodes
Submental
Submandibular (Submaxillary)
Anterior Cervical Lymph Nodes (Deep)
Prelaryngeal
Thyroid
Pretracheal
Paratracheal
Deep Cervical Lymph Nodes
Lateral jugular
Anterior jugular
Jugulodigastric
Inferior Deep Cervical Lymph Nodes
Juguloomohyoid
Supraclavicular (scalene) Illu lymph chain02.jpg
Deep Lymph Nodes
  1. Submental
  2. Submandibular (Submaxillary)
Anterior Cervical Lymph Nodes (Deep)
  1. Prelaryngeal
  2. Thyroid
  3. Pretracheal
  4. Paratracheal
Deep Cervical Lymph Nodes
  1. Lateral jugular
  2. Anterior jugular
  3. Jugulodigastric
Inferior Deep Cervical Lymph Nodes
  1. Juguloomohyoid
  2. Supraclavicular (scalene)

Cervical lymph nodes are lymph nodes found in the neck. Of the 800 lymph nodes in the human body, 300 are in the neck. [4] Cervical lymph nodes are subject to a number of different pathological conditions including tumours, infection and inflammation. [5]

Contents

Classification

There are approximately 300 lymph nodes in the neck, and they can be classified in a number of different ways. [4]

History

The classification of the cervical lymph nodes is generally attributed to Henri Rouvière in his 1932 publication "Anatomie des Lymphatiques de l'Homme" [6] [7] Rouviere described the cervical lymph nodes as a collar which surrounded the upper aerodigestive tract, consisting of submental, facial, submandibular, parotid, mastoid, occipital and retropharyngeal nodes, together with two chains that run in the long axis of the neck, the anterior cervical and postero-lateral cervical groups. [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. The most commonly used system is one based on a classification of the lymph nodes into numbered groupings, devised at the Memorial Sloan Kettering Cancer Center in the 1930s. This has been variously modified since. In 1991, the American Academy of Otolaryngology published a standardised version of this [9] to provide a uniform approach to neck dissection that was updated in 2002, including the addition of sub-levels, e.g. IIA and IIB. [2]

Modern systems

More recently, classification systems have been proposed organized around what can be observed via diagnostic imaging. [10] [8] [2] In addition to the American Academy of Otolaryngology, systems have been devised by the American Joint Committee on Cancer (AJCC). [10] The AJCC system from the 7th edition of the Staging Manual (2009) remains unchanged in the 8th edition of 2018. [11]

Lymph node levels

The American Academy of Otolaryngology system (2002) divides the nodes as follows: [1] [2] [3]

The American Joint Committee on Cancer (AJCC) system differs from the above by including Level VII, but the American Academy considered these to be anatomically mediastinal rather than cervical nodes, and therefore should not be included in the classification of neck nodes. [8] However it is based on the 2002 American Academy system, although the boundaries are defined slightly differently. [12]

The boundaries are defined as (Superior, Inferior, Antero-medial, Postero-lateral)

  • Level IA: Symphysis of mandible, Body of hyoid, Anterior belly of contralateral digastric muscle, Anterior belly of ipsilateral digastric muscle
  • Level IB: Body of mandible, Posterior belly of digastric muscle, Anterior belly of digastric muscle, Stylohyoid muscle
  • Level IIA: Skull base, Horizontal plane defined by the inferior border of the hyoid bone, The stylohyoid muscle, Vertical plane defined by the spinal accessory nerve
  • Level IIB: Skull base, Horizontal plane defined by the inferior body of the hyoid bone, Vertical plane defined by the spinal accessory nerve, Lateral border of the sternocleidomastoid muscle
  • Level III: Horizontal plane defined by the inferior body of hyoid, Horizontal plane defined by the inferior border of the cricoid cartilage, Lateral border of the sternohyoid muscle, Lateral border of the sternocleidomastoid or sensory branches of cervical plexus
  • Level IV: Horizontal plane defined by the inferior border of the cricoid cartilage, Clavicle, Lateral border of the sternohyoid muscle, Lateral border of the sternocleidomastoid or sensory branches of cervical plexus
  • Level VA: Apex of the convergence of the sternocleidomastoid and trapezius muscles, Horizontal plane defined by the lower border of the cricoid cartilage, Posterior border of the sternocleidomastoid muscle or sensory branches of cervical plexus, Anterior border of the trapezius muscle
  • Level VB: Horizontal plane defined by the lower border of the cricoid cartilage, Clavicle, Posterior border of the sternocleidomastoid muscle, Anterior border of the trapezius muscle
  • Level VI: Hyoid bone, Suprasternal notch, Common carotid artery, Common carotid artery
  • Level VII: Suprasternal notch, Innominate artery, Sternum, Trachea, esophagus, and prevertebral fascia

While an imaging based system was proposed in 1999, [10] these concepts were integrated into the 2002 revision of the American Academy system. [2] In addition to needing a standardised approach to classification of lymph nodes for the purposes of neck dissection, the application of radiation therapy also requires such an approach and has resulted in an international consensus guideline (2013). [13]

Clinical significance

Infectious mononucleosis (glandular fever) affects the cervical lymph nodes which become swollen. The characterization of cancerous lymph nodes on CT scan, 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. Involvement of the cervical lymph nodes with metastatic cancer is the single most important prognostic factor in head and neck squamous cell carcinoma and may be associated with a halving of survival. Where the cancer has penetrated the capsule of the lymph gland (extracapsular extension) survival may be decreased by a further 50%. Other important factors are the level, the number of nodes and their size, which are also correlated with the risk of distant metastases. Cervical lymph node metastasis is also a common feature of papillary thyroid carcinoma. [14] [15]

Additional images

Related Research Articles

<span class="mw-page-title-main">Neck</span> Part of the body on many vertebrates that connects the head with the torso

The neck is the part of the body on many vertebrates that connects the head with the torso. The neck supports the weight of the head and protects the nerves that carry sensory and motor information from the brain down to the rest of the body. In addition, the neck is highly flexible and allows the head to turn and flex in all directions. The structures of the human neck are anatomically grouped into four compartments; vertebral, visceral and two vascular compartments. Within these compartments, the neck houses the cervical vertebrae and cervical part of the spinal cord, upper parts of the respiratory and digestive tracts, endocrine glands, nerves, arteries and veins. Muscles of the neck are described separately from the compartments. They bound the neck triangles.

Articles related to anatomy include:

<span class="mw-page-title-main">Accessory nerve</span> Cranial nerve XI, for head and shoulder movements

The accessory nerve, also known as the eleventh cranial nerve, cranial nerve XI, or simply CN XI, is a cranial nerve that supplies the sternocleidomastoid and trapezius muscles. It is classified as the eleventh of twelve pairs of cranial nerves because part of it was formerly believed to originate in the brain. The sternocleidomastoid muscle tilts and rotates the head, whereas the trapezius muscle, connecting to the scapula, acts to shrug the shoulder.

<span class="mw-page-title-main">Levator scapulae muscle</span> Slender skeletal muscle at the back and side of the neck

The levator scapulae is a slender skeletal muscle situated at the back and side of the neck. It originates from the transverse processes of the four uppermost cervical vertebrae; it inserts onto the upper portion of the medial border of the scapula. It is innervated by the cervical nerves C3-C4, and frequently also by the dorsal scapular nerve. As the Latin name suggests, its main function is to lift the scapula.

<span class="mw-page-title-main">Omohyoid muscle</span> Human neck muscle

The omohyoid muscle is a muscle in the neck. It is one of the infrahyoid muscles. It consists of two bellies separated by an intermediate tendon. Its inferior belly is attached to the scapula; its superior belly is attached to the hyoid bone. Its intermediate tendon is anchored to the clavicle and first rib by a fascial sling. The omohyoid is innervated by the ansa cervicalis of the cervical plexus. It acts to depress the hyoid bone.

<span class="mw-page-title-main">Neck dissection</span> Surgical procedure

The neck dissection is a surgical procedure for control of neck lymph node metastasis from squamous cell carcinoma (SCC) of the head and neck. The aim of the procedure is to remove lymph nodes from one side of the neck into which cancer cells may have migrated. Metastasis of squamous cell carcinoma into the lymph nodes of the neck reduce survival and is the most important factor in the spread of the disease. The metastases may originate from SCC of the upper aerodigestive tract, including the oral cavity, tongue, nasopharynx, oropharynx, hypopharynx, and larynx, as well as the thyroid, parotid and posterior scalp.

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In anatomy, the left and right common carotid arteries (carotids) are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external and internal carotid arteries.

<span class="mw-page-title-main">Triangles of the neck</span>

Anatomists use the term triangles of the neck to describe the divisions created by the major muscles in the region.

<span class="mw-page-title-main">Posterior triangle of the neck</span>

The posterior triangle is a region of the neck.

<span class="mw-page-title-main">Transverse cervical artery</span> Artery of the neck

The transverse cervical artery is an artery in the neck and a branch of the thyrocervical trunk, running at a higher level than the suprascapular artery.

<span class="mw-page-title-main">Deep cervical fascia</span>

The deep cervical fascia lies under cover of the platysma, and invests the muscles of the neck; it also forms sheaths for the carotid vessels, and for the structures situated in front of the vertebral column. Its attachment to the hyoid bone prevents the formation of a dewlap.

<span class="mw-page-title-main">Carotid triangle</span>

The carotid triangle is a portion of the anterior triangle of the neck.

<span class="mw-page-title-main">Muscular triangle</span>

The inferior carotid triangle, is bounded, in front, by the median line of the neck from the hyoid bone to the sternum; behind, by the anterior margin of the sternocleidomastoid; above, by the superior belly of the omohyoid.

<span class="mw-page-title-main">Subclavian triangle</span>

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<span class="mw-page-title-main">Superior deep cervical lymph nodes</span> Lymphatic Organs

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<span class="mw-page-title-main">Submental lymph nodes</span>

The submental lymph nodes are 2-3 lymph nodes situated in the submental triangle, between the anterior bellies of the digastric muscle and the hyoid bone.

<span class="mw-page-title-main">Outline of human anatomy</span> Overview of and topical guide to human anatomy

The following outline is provided as an overview of and topical guide to human anatomy:

<span class="mw-page-title-main">Parapharyngeal space</span>

The parapharyngeal space, is a potential space in the head and the neck. It has clinical importance in otolaryngology due to parapharyngeal space tumours and parapharyngeal abscess developing in this area. It is also a key anatomic landmark for localizing disease processes in the surrounding spaces of the neck; the direction of its displacement indirectly reflects the site of origin for masses or infection in adjacent areas, and consequently their appropriate differential diagnosis.

<span class="mw-page-title-main">Submandibular space</span>

The submandibular space is a fascial space of the head and neck. It is a potential space, and is paired on either side, located on the superficial surface of the mylohyoid muscle between the anterior and posterior bellies of the digastric muscle. The space corresponds to the anatomic region termed the submandibular triangle, part of the anterior triangle of the neck.

<span class="mw-page-title-main">Submental space</span>

The submental space is a fascial space of the head and neck. It is a potential space located between the mylohyoid muscle superiorly, the platysma muscle inferiorly, under the chin in the midline. The space coincides with the anatomic region termed the submental triangle, part of the anterior triangle of the neck.

References

  1. 1 2 Buyten 2006.
  2. 1 2 3 4 5 Robbins et al 2002.
  3. 1 2 Brekel et al 1998.
  4. 1 2 Mukherji 2002.
  5. Eisenmenger & Wiggins 2015.
  6. Rouvière 1932.
  7. JAMA 1932.
  8. 1 2 3 Chong 2004.
  9. Robbins et al 1991.
  10. 1 2 3 Som et al 1999.
  11. AJCC 2018.
  12. AJCC 2009.
  13. Gregoire et al 2013.
  14. Chen et al 2015.
  15. Park et al 2015.

Bibliography