CERVICAL METASTASESCERVICAL METASTASES CERVICAL METASTASESCERVICAL METASTASES Assessment of a neck massAssessment of a neck mass

M. Hosseini M.D.M. Hosseini M.D. Head & Neck SurgeonHead & Neck Surgeon

Rasool Akram HospitalRasool Akram Hospital

Iran UniversityIran University

Assessment of a neck massAssessment of a neck mass

M. Hosseini M.D.M. Hosseini M.D. Head & Neck SurgeonHead & Neck Surgeon

Rasool Akram HospitalRasool Akram Hospital

Iran UniversityIran University

L . N .L . N .

Occipital

Postauricular

Preauricular

Parotid

Facial A.N.

Occipital

Postauricular

Preauricular

Parotid

Facial A.N.

NomberNomber

1 - 31 - 3

22

2

6 - 86 - 8

11

Infraorbital (maxillary)

Buccinator

Supramandibular

Submandibular

Submental (Suprahyoid)

Internal jugular

Spinal accessory

Transverse

Infraorbital (maxillary)

Buccinator

Supramandibular

Submandibular

Submental (Suprahyoid)

Internal jugular

Spinal accessory

Transverse

5 - 85 - 8

3 - 63 - 6

2 - 32 - 3

10 - 2010 - 20

2020

4 - 124 - 12

Drainage patternsDrainage patternsDrainage patternsDrainage patterns

- Lymphatic flow change in the neoplastic & - Lymphatic flow change in the neoplastic &

postsurgical state.postsurgical state.

- Lymphatic flow change in the neoplastic & - Lymphatic flow change in the neoplastic &

postsurgical state.postsurgical state.

Parotid node :Parotid node :Parotid node :Parotid node :

- Root of the nose- Root of the nose

- Eyelids- Eyelids

- Frontotemoral skin- Frontotemoral skin

- External auditory meatas- External auditory meatas

- Tympanic cavity - Tympanic cavity

- Root of the nose- Root of the nose

- Eyelids- Eyelids

- Frontotemoral skin- Frontotemoral skin

- External auditory meatas- External auditory meatas

- Tympanic cavity - Tympanic cavity

Preauricular (superficial parotid N.) :Preauricular (superficial parotid N.) :Preauricular (superficial parotid N.) :Preauricular (superficial parotid N.) :

- Anterior (Lateral)- Anterior (Lateral) of auricle of auricle

- Skin of the adjacent temporal region- Skin of the adjacent temporal region

- Anterior (Lateral)- Anterior (Lateral) of auricle of auricle

- Skin of the adjacent temporal region- Skin of the adjacent temporal region

Postauricular N. (mastoid)Postauricular N. (mastoid)Postauricular N. (mastoid)Postauricular N. (mastoid)

- Postauricular area - Postauricular area

- Posterior aspects of the pinna- Posterior aspects of the pinna

- External auditory- External auditory canalcanal

- Postauricular area - Postauricular area

- Posterior aspects of the pinna- Posterior aspects of the pinna

- External auditory- External auditory canalcanal

Occipital node :Occipital node :Occipital node :Occipital node :

Scalp over the occipital portionScalp over the occipital portion

Of the skullOf the skull

Scalp over the occipital portionScalp over the occipital portion

Of the skullOf the skull

Submandibular nodes :Submandibular nodes :Submandibular nodes :Submandibular nodes :

- Side & vestibular aspect of the nose- Side & vestibular aspect of the nose

- Upper Lip - Upper Lip

- The most lateral part of the lower lip- The most lateral part of the lower lip

- The gums- The gums

- The anterior aspect of the tongue margin- The anterior aspect of the tongue margin

- Part of the lateral floor of mouth- Part of the lateral floor of mouth

- Side & vestibular aspect of the nose- Side & vestibular aspect of the nose

- Upper Lip - Upper Lip

- The most lateral part of the lower lip- The most lateral part of the lower lip

- The gums- The gums

- The anterior aspect of the tongue margin- The anterior aspect of the tongue margin

- Part of the lateral floor of mouth- Part of the lateral floor of mouth

Superior deep jugular nodes : Superior deep jugular nodes : Superior deep jugular nodes : Superior deep jugular nodes : - Soft palate- Soft palate- Palatine tonsil & pillars- Palatine tonsil & pillars- Posterior oral tongue- Posterior oral tongue- Tongue base- Tongue base- Piriform sinuses- Piriform sinuses- Supraglottic larynx- Supraglottic larynx- Retropharyngeal- Retropharyngeal- Spinal accessory- Spinal accessory- Parotid - Parotid - Superficial cervical- Superficial cervical- Submandibular - Submandibular

- Soft palate- Soft palate- Palatine tonsil & pillars- Palatine tonsil & pillars- Posterior oral tongue- Posterior oral tongue- Tongue base- Tongue base- Piriform sinuses- Piriform sinuses- Supraglottic larynx- Supraglottic larynx- Retropharyngeal- Retropharyngeal- Spinal accessory- Spinal accessory- Parotid - Parotid - Superficial cervical- Superficial cervical- Submandibular - Submandibular

Middle deep cervical nodes :Middle deep cervical nodes :Middle deep cervical nodes :Middle deep cervical nodes :

- Supraglottic Larynx- Supraglottic Larynx

- Lower piriform sinus- Lower piriform sinus

- Posterior cricoid area- Posterior cricoid area

- Inferior retropharyngeal nodes- Inferior retropharyngeal nodes

- Superior jugular nodes- Superior jugular nodes

- Supraglottic Larynx- Supraglottic Larynx

- Lower piriform sinus- Lower piriform sinus

- Posterior cricoid area- Posterior cricoid area

- Inferior retropharyngeal nodes- Inferior retropharyngeal nodes

- Superior jugular nodes- Superior jugular nodes

Spinal Accessory nodesSpinal Accessory nodesSpinal Accessory nodesSpinal Accessory nodes

- Parietal & occipital regions of the scalp - Parietal & occipital regions of the scalp

- Upper retropharyngeal & Parapharyngeal- Upper retropharyngeal & Parapharyngeal

nodes draining the nasopharynx & paranasalnodes draining the nasopharynx & paranasal

sinuses.sinuses.

- More cephalic spinal accessory nodes drain - More cephalic spinal accessory nodes drain

into the superior deep cervical nodes , into the superior deep cervical nodes ,

whereas the more inferior have connectionwhereas the more inferior have connection

with supraclavicularwith supraclavicular

- Parietal & occipital regions of the scalp - Parietal & occipital regions of the scalp

- Upper retropharyngeal & Parapharyngeal- Upper retropharyngeal & Parapharyngeal

nodes draining the nasopharynx & paranasalnodes draining the nasopharynx & paranasal

sinuses.sinuses.

- More cephalic spinal accessory nodes drain - More cephalic spinal accessory nodes drain

into the superior deep cervical nodes , into the superior deep cervical nodes ,

whereas the more inferior have connectionwhereas the more inferior have connection

with supraclavicularwith supraclavicular

Supraclavicular :Supraclavicular :Supraclavicular :Supraclavicular :

- Metastases from infraclavicular primary - Metastases from infraclavicular primary tumorstumors

- Cervical esophagus- Cervical esophagus

- Thyroid- Thyroid

- Nasopharynx (rare) - Nasopharynx (rare)

- Metastases from infraclavicular primary - Metastases from infraclavicular primary tumorstumors

- Cervical esophagus- Cervical esophagus

- Thyroid- Thyroid

- Nasopharynx (rare) - Nasopharynx (rare)

Nasopharynx & piriform sinuses have the mostNasopharynx & piriform sinuses have the most

Profuse networks of capillary lymphatics,Profuse networks of capillary lymphatics,

Whereas the paranasal sinus , midlle ear &Whereas the paranasal sinus , midlle ear &

True vocal cords have minimal or no lymphatics.True vocal cords have minimal or no lymphatics.

Nasopharynx & piriform sinuses have the mostNasopharynx & piriform sinuses have the most

Profuse networks of capillary lymphatics,Profuse networks of capillary lymphatics,

Whereas the paranasal sinus , midlle ear &Whereas the paranasal sinus , midlle ear &

True vocal cords have minimal or no lymphatics.True vocal cords have minimal or no lymphatics.

Metastases from an unknown primary Metastases from an unknown primary malignancymalignancy

Metastases from an unknown primary Metastases from an unknown primary malignancymalignancy

- Lymph nodes contain metastatic S.C.C. %90 in - Lymph nodes contain metastatic S.C.C. %90 in

the H & N.the H & N.

- Nasopharynx , hypopharynx , esophagus , Larynx ,- Nasopharynx , hypopharynx , esophagus , Larynx ,

tracheobronchialtracheobronchial

- Malignant melanoma in cervical L.N. (previous skin - Malignant melanoma in cervical L.N. (previous skin

Lesions – scalp nose – oral cavity – sinus –Lesions – scalp nose – oral cavity – sinus –

ophthalmologic exam.) ophthalmologic exam.)

- Metastatic adenocar. Salivary glands – thyroid –- Metastatic adenocar. Salivary glands – thyroid –

breast – Gi tract – genitourinary tract – pelvic tumors breast – Gi tract – genitourinary tract – pelvic tumors – prostate– prostate

- Lymph nodes contain metastatic S.C.C. %90 in - Lymph nodes contain metastatic S.C.C. %90 in

the H & N.the H & N.

- Nasopharynx , hypopharynx , esophagus , Larynx ,- Nasopharynx , hypopharynx , esophagus , Larynx ,

tracheobronchialtracheobronchial

- Malignant melanoma in cervical L.N. (previous skin - Malignant melanoma in cervical L.N. (previous skin

Lesions – scalp nose – oral cavity – sinus –Lesions – scalp nose – oral cavity – sinus –

ophthalmologic exam.) ophthalmologic exam.)

- Metastatic adenocar. Salivary glands – thyroid –- Metastatic adenocar. Salivary glands – thyroid –

breast – Gi tract – genitourinary tract – pelvic tumors breast – Gi tract – genitourinary tract – pelvic tumors – prostate– prostate