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Captcha Image Reload image challenge



Authors : Dr. Suraj Agarwal .
 

Abstract:

For over five decades, the principle landmarks used in cervical nodal classification were clinical and defined either by palpation or found at the operative table. However during the past two decades, sectional imaging has consistently improved its quality and resolution and it has been shown that imaging can identify deep structures and adenopathy not amenable to palpation. Such disease can alter planned operative or radiation fields.This classification was developed in consultation with head and neck surgeons so that the nodal levels classified by this imaging-based system would correspond closely with the nodal levels determined by utilizing the most commonly employed clinically-based classifications. This pictorial assay describes this imaging-based classification and demonstrates its use with axial diagrams.
 
 
Fig: 1(A) SUBMENTAL NODES
Superior: plane of geniohyoid
Caudal: plane of hyoid
Anterior: syphysismenti
Lateral: medial margins of digastric muscle.
Posterior: anterior to body of hyoid
 
Fig: 1(B) SUBMENTAL NODES
Superior: Mylohyoid or superior subandibulargland
Caudal: Hyoid Bone
Anterior: SymphysisMentii
Lateral: Mandibular Arch, Platysa
Posterior: Posterior Margin of the Submandibular Gland
Medial: Medial Edge Anterior Digastric Muscle
 
Fig: 2 UPPER JUGULAR NODES
Superior: Skull Base or caudal edge of lateral process of C1.
Caudal: Caudal Edge of Hyoid
Lateral: Medial edge of Sternocleidomastoid Muscle
Medial: Medial Border of ICA
 
Fig: 2(A) UPPER JUGULAR NODES
IIA: Anterior to Spinal Accessory Nerve
Anterior, Medial, Lateral or posterior to IJV.
If posterior, the lyph node is inseparable from the IJV.
 
Fig: 2(B) UPPER JUGULAR NODES
IIB: Posterior to spinal Accessory Nerve
Posterior or posterolateral to the IJV & has a fat plane
separating the node and the vein.
 
Fig: 3 MIDDLE JUGULAR NODES
Located between bottom of hyoid body to bottom of cricoid arch
Lateral to Carotids
Anterior to the posterior margin of the Sternocleidomastoid Muscle
Anterior Limit = Anterior Border of Sternocleidomastoid Muscle.
 
Fig: 4 LOWER JUGULAR NODES
From level of the inerior cricoid arch to the clavicle
or 2cm cranial to sternoclavicular joint
Lateral to Carotids
Anterior to the Posterior Margin of Sternocleidomastoid Muscle.
 
Fig: 5 POSTERIOR TRAINGLE NODES
From level of the inerior cricoid arch to the clavicle
or 2cm cranial to sternoclavicular joint
Lateral to Carotids
Anterior to the Posterior Margin of Sternocleidomastoid Muscle
 
Fig: 6 CENTRAL COMPARTMENT NODES
Upper visceral nodes
Superior Level = Hyoid Bone
Between carotids
Inferior level= the top of manubrium
 
Fig: 7 SUPERIOR MEDIASTINAL NODES
Between carotids
Below level of the top of the manubrium
Above level of innominate vein
 
Fig: 8 RETROPHARYNGEAL NODES:
Medial to carotids
Within 2cm of skull base to the level of hyoid or C3.
 
SUPRACLAVICLULAR NODES
Lie at, or caudal to the level of clavicle
Lateral to the Carotids
FACIAL NODES
 
SUMMARY OF THE LEVEL OF LYMPH NODES (COMPARTMENTLIZATION)
 

Reference:

  1. Peter M Som, Hugh D Curtin; Head & Neck Imaging- 2nd Volume, 5th Edition.
  2. Franz J Wippold; Head & Neck Imaging; Role of CT & MRI; Journal of Magnetic Resonance Imaging; 25:453-465

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