Cervical lymph nodes

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

Video Cervical lymph nodes

Classification

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

History

The classification of the cervical lymph nodes is generally attributed to Henri Rouvière in his 1932 publication "Anatomie des Lymphatiques de l'Homme" 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 that was updated in 2002.

Modern systems

More recently, classification systems have been proposed organized around what can be observed via diagnostic imaging.

Commonly used systems have been devised by the American Academy of Otolaryngology and the American Joint Committee on Cancer.

One system divides the nodes as follows:

• Level I: Submental and submandibular nodes
  • Level Ia: Submental - found between the anterior belly of the digastric muscles
  • Level Ib: Submandibular triangle - found around submandibular glands in submandibular space
• Level II: Upper jugular nodes (Subdigastric 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 - between the hyoid bone and cricoid cartilage
• Level IV: Lower jugular nodes - between the cricoid cartilage and the clavicle
• Level V: 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

Maps Cervical lymph nodes

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. Cervical lymph node metastasis is a common feature of papillary thyroid carcinoma

src: pedsinreview.aappublications.org

Additional images

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References

src: www.earthslab.com

Bibliography

src: heritance.me

External links

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

Source of article : Wikipedia