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]

Cervical lymph nodes
Lymph node regions
Regional lymph tissue (Cervical near top, in blue)
Cervical lymph node groups
Numbering of cervical lymph node groups
Details
SystemLymphatic system
Identifiers
LatinNodi lymphoidei cervicales
Anatomical terminology
Illu lymph chain02
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)
Gray602
Superficial lymph glands and lymphatic vessels of head and neck

Classification

There are approximately 300 lymph nodes in the neck, and they can be classified in a number of different ways.[1]

History

The classification of the cervical lymph nodes is generally attributed to Henri Rouvière in his 1932 publication "Anatomie des Lymphatiques de l'Homme" [3][4] 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.[5]

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[6]to provide a uniform approach to neck dissection that was updated in 2002, including the addition of sub-levels, e.g. IIA and IIB.[7]

Modern systems

More recently, classification systems have been proposed organized around what can be observed via diagnostic imaging.[8][5][7] In addition to the American Academy of Otolaryngology, systems have been devised by the American Joint Committee on Cancer (AJCC).[8] The AJCC system from the 7th edition of the Staging Manual (2009) remains unchanged in the 8th edition of 2018.[9]

The American Academy of Otolaryngology system (2002) divides the nodes as follows:[10][7][11]

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.[5] However it is based on the 2002 American Academy system, although the boundaries are defined sklightly 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 diagastric 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,[8] these concepts were integrated into the 2002 revision of the American Academy system.[7] 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

Gray603

Lymphatics of pharynx.

Gray604

The lymphatics of the face.

References

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

Bibliography

External links

Anterior cervical lymph nodes

The anterior cervical lymph nodes are a group of nodes found on the anterior part of the neck, in front of the sternocleidomastoid muscle. These can be grouped into a deep and superficial group.

The superficial group drain the superficial surfaces of the anterior neck.

Cervical lymphadenopathy

Cervical lymphadenopathy refers to lymphadenopathy of the cervical lymph nodes (the glands in the neck). The term lymphadenopathy strictly speaking refers to disease of the lymph nodes, though it is often used to describe the enlargement of the lymph nodes. Similarly, the term lymphadenitis refers to inflammation of a lymph node, but often it is used as a synonym of lymphadenopathy.

Cervical lymphadenopathy is a sign or a symptom, not a diagnosis. The causes are varied, and may be inflammatory, degenerative, or neoplastic. In adults, healthy lymph nodes can be palpable (able to be felt), in the axilla, neck and groin. In children up to the age of 12 cervical nodes up to 1 cm in size may be palpable and this may not signify any disease. If nodes heal by resolution or scarring after being inflamed, they may remain palpable thereafter. In children, most palpable cervical lymphadenopathy is reactive or infective. In individuals over the age of 50, metastatic enlargement from cancers (most commonly squamous cell carcinomas) of the aerodigestive tract should be considered.

Deep anterior cervical lymph nodes

The deep anterior cervical lymph nodes are found near the middle cricothyroid ligament and the trachea.

Deep cervical lymph nodes

The deep cervical lymph nodes are a group of cervical lymph nodes found near the internal jugular vein.They can be divided into upper and lower groups, or superior and inferior groups.Alternatively, they can be divided into deep anterior cervical lymph nodes and deep lateral cervical lymph nodes.

They can also be divided into three groups: "superior deep jugular", "middle deep jugular", and "inferior deep jugular".

Deep lateral cervical lymph nodes

The deep lateral cervical lymph nodes are found near the upper part of the internal jugular vein in the neck, lateral or posterior to the carotid sheath.

Inferior deep cervical lymph nodes

The inferior deep cervical lymph nodes extend beyond the posterior margin of the sternocleidomastoid muscle into the subclavian triangle, where they are closely related to the brachial plexus and subclavian vein.

Jugular lymph trunk

The jugular trunk is a lymphatic vessel in the neck. It is formed by vessels that emerge from the superior deep cervical lymph nodes and unite to efferents of the inferior deep cervical lymph nodes.

On the right side, this trunk ends in the junction of the internal jugular and subclavian veins, called the venous angle. On the left side it joins the thoracic duct.

Jugulo-omohyoid lymph node

The juguloomohyoid lymph node (tongue node) is related to the intermediate tendon of the omohyoid muscle. It is designated as one of the deep cervical lymph nodes. As it is associated with the lymph drainage of the tongue if enlarged, it can be a sign of a tongue carcinoma.

Jugulodigastric lymph node

The jugulodigastric lymph node is a large node found in the proximity of where the posterior belly of the digastric muscle crosses the internal jugular vein.

Enlarged tender jugulodigastric nodes, if accompanying exudative pharyngitis, is likely to be of Streptococcal etiology. Enlarged jugulodigastric lymph nodes are also commonly found in tonsillitis.

Lateral cervical lymph nodes

The lateral cervical lymph nodes are a group of lymph nodes found in the lateral side of the neck.

Terminologia Anatomica divides them into:

Superficial lateral cervical lymph nodes

Deep lateral cervical lymph nodesAnother source divides this group into "internal jugular", "spinal accessory", and "transverse cervical".

List of lymph nodes of the human body

Humans have approximately 500–600 lymph nodes distributed throughout the body, with clusters found in the underarms, groin, neck, chest, and abdomen.

Neck

The neck is the part of the body, on many vertebrates, that separates the head from the torso. It contains blood vessels and nerves that supply structures in the head to the body. These in humans include part of the esophagus, the larynx, trachea, and thyroid gland, major blood vessels including the carotid arteries and jugular veins, and the top part of the spinal cord.

In anatomy, the neck is also called by its Latin names, cervix or collum, although when used alone, in context, the word cervix more often refers to the uterine cervix, the neck of the uterus. Thus the adjective cervical may refer either to the neck (as in cervical vertebrae or cervical lymph nodes) or to the uterine cervix (as in cervical cap or cervical cancer).

Paratracheal lymph nodes

The right and left paratracheal lymph nodes (or paratracheal chains) are groups of lymph nodes located in the throat.

Retropharyngeal lymph nodes

The retropharyngeal lymph nodes, from one to three in number, lie in the buccopharyngeal fascia, behind the upper part of the pharynx and in front of the arch of the atlas, being separated, however, from the latter by the Longus capitis.

Their afferents drain the nasal cavities, the nasal part of the pharynx, and the auditory tubes.

Their efferents pass to the superior deep cervical lymph nodes.

They are in the retropharyngeal space.They frequently disappear by age 4-5. (This is why retropharyngeal abscess is rare in older children.)

Submandibular lymph nodes

The submandibular lymph nodes (submaxillary glands in older texts), three to six in number, are placed beneath the body of the mandible in the submaxillary triangle, and rest on the superficial surface of the submandibular gland.

One gland, the middle gland of Stahr, which lies on the external maxillary artery as it turns over the mandible, is the most constant of the series; small lymph glands are sometimes found on the deep surface of the submandibular gland.

The afferents of the submandibular glands drain the medial palpebral commissure, the cheek, the side of the nose, the upper lip, the lateral part of the lower lip, the gums, and the anterior part of the margin of the tongue.

Efferent vessels from the facial and submental glands also enter the submaxillary glands. Their efferent vessels pass to the superior deep cervical lymph nodes.

Superficial anterior cervical lymph nodes

The superficial anterior cervical lymph nodes are found in proximity to the anterior jugular vein.

Superficial cervical lymph nodes

The superficial cervical lymph nodes are lymph nodes that lie near the surface of the neck.

Some sources state simply that they lie along the external jugular vein, while other sources state that they are only adjacent to the external jugular vein in the posterior triangle, and they are adjacent to the anterior jugular vein in the anterior triangle.They can be broken down into:

superficial anterior cervical lymph nodes

superficial lateral cervical lymph nodes

Superficial lateral cervical lymph nodes

The superficial lateral cervical lymph nodes are found in proximity to the external jugular vein.

Superior deep cervical lymph nodes

The superior deep cervical lymph nodes lie under the sternocleidomastoid muscle in close relation with the accessory nerve and the internal jugular vein.

Some of the glands lie in front of and others behind the vessel. Lymph from these deep nodes passes to the jugular lymphatic trunk, which joins the thoracic duct on the left side and the brachiocephalic vein on the right side.

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