📝 “What are the Key Structures & Boundaries of the Modified Neck Dissection?”

- 9.25.24

Quick Review #234 - #pathology #oralpathology #doctorgallagher #oralsurgery #oralsurgeon #dentist #dentistry #dental #cancer #neckdissection #surgery #surgeon

The neck is divided into six levels for the purposes of lymph node dissection. Each level contains different groups of lymph nodes, and understanding their anatomical boundaries helps guide the dissection.

Level I (Submental and Submandibular Triangles):

Boundaries:

• Superior: Mandible

• Inferior: Hyoid bone

• Medial: Midline of the neck

• Lateral: Anterior belly of the digastric muscle (submental triangle) and posterior belly of the digastric muscle (submandibular triangle).

Key Structures:

• Submandibular gland, marginal mandibular branch of the facial nerve, lingual nerve, hypoglossal nerve (CN XII).

Level II (Upper Jugular Nodes):

Boundaries:

• Superior: Base of the skull

• Inferior: Hyoid bone

• Anterior: Stylohyoid muscle

• Posterior: Posterior border of the sternocleidomastoid muscle

Key Structures:

• Spinal accessory nerve (cranial nerve XI), internal jugular vein, hypoglossal nerve (CN XII).

Level III (Mid-Jugular Nodes):

Boundaries:

• Superior: Hyoid bone

• Inferior: Cricoid cartilage

• Anterior: Sternohyoid muscle

• Posterior: Posterior border of the sternocleidomastoid muscle

Key Structures:

• Internal jugular vein, sternocleidomastoid muscle, cervical sensory nerves (cervical plexus).

Level IV (Lower Jugular Nodes):

Boundaries:

• Superior: Cricoid cartilage

• Inferior: Clavicle

• Anterior: Sternohyoid muscle

• Posterior: Posterior border of the sternocleidomastoid muscle

Key Structures:

• Internal jugular vein, phrenic nerve, brachial plexus, and thoracic duct (on the left).

Level V (Posterior Triangle):

Boundaries:

• Superior: Base of the skull

• Inferior: Clavicle

• Anterior: Posterior border of the sternocleidomastoid muscle

• Posterior: Anterior border of the trapezius muscle

Key Structures:

• Spinal accessory nerve (cranial nerve XI), cervical plexus, subclavian artery, and vein.

Level VI (Anterior Compartment):

Boundaries:

• Superior: Hyoid bone

• Inferior: Suprasternal notch

• Lateral: Carotid sheaths

Key Structures:

• Thyroid gland, parathyroid glands, recurrent laryngeal nerves, trachea, esophagus, and inferior thyroid artery.

References:

1. Welch, K., & McHenry, C. R. (2013). Selective lateral compartment neck dissection for thyroid cancer. Journal of Surgical Research

2. Robbins, K. T., Ferlito, A., Shah, J. P., Medina, J. E., Silver, C. E., Hamoir, M., … & Rinaldo, A. (2008). The evolving role of selective neck dissection for head and neck squamous cell carcinoma. European Archives of Oto-Rhino-Laryngology, 265(5), 499-504.

3. Shah, J. P., & Patel, S. G. (2012). Head and neck surgery and oncology (4th ed.). Elsevier.

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