Grupos ganglionares en cuello

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Division of Neck Levels by Sublevels
The 2001 report of the American Head and Neck Society's Neck Dissection Committee recommended the use of sublevels for defining selected lymph node groups within levels I, II, and V on the basis of the biologic significance, independent of the larger zone in which they lay.[21] These are outlined in Figure 121-2 as sublevels IA (submental nodes), IB(submandibular nodes), IIA and IIB (together composing the upper jugular nodes), VA (spinal accessory nodes), and VB (transverse cervical and supraclavicular nodes). The boundaries for each of these sublevels are defined in Table 121-2.
|[pic] |
|Figure 121-2. The six sublevels of the neck for describing the location of lymph nodes within levels I, II, and V. IA, submental|[|
|group; IB, submandibular group; IIA, upper jugular nodes along the carotid sheath including the subdigastric group; IIB, upper |p|
|jugular nodes in the submuscularrecess; VA, spinal accessory nodes; and VB, the supraclavicular and transverse cervical nodes. |i|
|(Redrawn from art provided courtesy of Douglas Denys, MD.) |c|
| |]|


Table 121-2 --Lymph Node Groups Found within the Six Neck Levels and the Six Sublevels
|Lymph Node Group |Description |
|Submental (sublevel IA) |Lymph nodes within the triangular boundary of the anterior belly of the digastric muscles and the |
| |hyoid bone; these nodesare at the greatest risk of harboring metastases from cancers arising from the|
| |floor of the mouth, anterior oral tongue, anterior mandibular alveolar ridge, and lower lip (see Fig. |
| |121-2). |
|Submandibular (sublevel IB) |Lymph nodeswithin the boundaries of the anterior belly of the digastric muscle, the stylohyoid |
| |muscle, and the body of the mandible, including the preglandular and postglandular nodes and the |
| |prevascular and postvascular nodes. The submandibular gland is included in the specimen when the lymph|
||nodes within this triangle are removed. These nodes are at greatest risk for harboring metastases from|
| |cancers arising from the oral cavity, the anterior nasal cavity, and the soft tissue structures of the|
| |midface and the submandibular gland (see Fig. 121-3). |
|Upper jugular (sublevelsIIA |Lymph nodes located around the upper third of the internal jugular vein and the adjacent spinal |
|and IIB) |accessory nerve, extending from the level of the skull base above to the level of the inferior border |
| |of the hyoid bone below. The anterior (medial) boundary is the stylohyoid muscle (the radiologic |
||correlate is the vertical plane defined by the posterior surface of the submandibular gland), and the |
| |posterior (lateral) boundary is the posterior border of the sternocleidomastoid muscle. Sublevel IIA |
| |nodes are located anterior (medial) to the vertical plane defined by the spinal accessory nerve. |
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