Lymph node distribution in the central compartment of the neck: an anatomic study
Marcos Roberto Tavares1, José Arnaldo Shiomi da Cruz, Daniel Reis Waisberg
1Department of Head and Neck Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
Head & Neck
|September 17, 2013
Summary
Central neck dissection for thyroid cancer involves risks to nerves and glands. This study mapped lymph node distribution in the central neck, finding most nodes pretracheally, aiding surgical planning.
Area of Science:
- Anatomy
- Surgical Oncology
- Head and Neck Surgery
Background:
- Central compartment neck dissection (CCN) is crucial for thyroid carcinoma staging.
- Risk of recurrent laryngeal nerve and parathyroid gland injury during CCN dissection.
- Understanding central neck lymph node distribution is vital for surgical precision.
Purpose of the Study:
- To anatomically map the distribution of lymph nodes within the central compartment of the neck (CCN).
- To provide detailed data on lymph node locations relative to key anatomical structures.
- To inform surgical strategies for thyroid cancer treatment and minimize operative risks.
Main Methods:
- Dissection of 30 fresh cadavers to analyze CCN lymph node distribution.
- Systematic removal and pathological examination of soft tissues within defined CCN sublevels.
- Identification of nodules by palpation and confirmation through microscopic examination.
Main Results:
- Macroscopic identification of 3-44 nodules, with 2-42 confirmed as lymph nodes.
- Lymph node distribution: 0.9±0.72 precricoid, 12.4±8.19 pretracheal, 3.4±2.34 lateral to right RLN, 1.7±1.30 lateral to left RLN.
- Innominate vein located 15-35 mm below clavicles (left) and 5-45 mm (right); 26 parathyroid glands identified in 14 dissections.
Conclusions:
- Confirmed lymph node counts in the central neck ranged from 2 to 42.
- Approximately 67% of central neck lymph nodes are located in the pretracheal sublevel.
- Parathyroid glands were found distant from the thyroid gland, and no clear division between levels VI and VII lymph nodes was observed.
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