Localization of Head & Neck Lymph Node, Imaging Classification: A Pictorial Assay

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