Chapter 119 Neck Dissection

Question 1

Boundaries of submental triangle

Answer 1

Anterior belly of digastric muscles.

Hyoid bone.

Question 2

Boundaries of submental triangle

Answer 2

Anterior belly of digastric muscles.

Hyoid bone.

Question 3

Boundaries of submandibular triangle.

Answer 3

Anterior and Posterior Belly of Digastric.

Body of Mandible.

Question 4

Primary sites from which metastatic disease may originate if level I lymph nodes are involved:

Answer 4

lip
buccal mucosa
anterior nasal cavity
soft tissue of the cheek

Question 5

Proposed Radiologic landmark for medial boundary of Level II lymph nodes.

Answer 5

perpendicular plane defined by the posterior aspect of the submandibular gland.

Question 6

Boundaries of level II LNs:

Answer 6

Superior: skull base

Inferior: inferior border of hyoid bone

Anterior (medial)l:
- clinical - stylohyoid muscles
radiologic - vertical plane defined by posterior surface of the submandibular gland.

Posterior (lateral))

Question 7

Sublevel II A vs. II B: how to differentiate

Answer 7

vertical plane defined by the spinal accessory nerve.

Question 8

Boundaries of submandibular triangle.

Answer 8

Anterior and Posterior Belly of Digastric.

Body of Mandible.

Question 9

Corresponding areas which may harbor metastasis: Level IA

Answer 9

Floor of mouth

Anterior oral tongue

Anterior mandibular alveolar ridge

Lower lip

Question 10

Corresponding areas which may harbor metastasis: Level IB

Answer 10

Oral cavity

Anterior nasal cavity

Soft tissue structures of midface

Submandibular gland

Question 11

Boundaries of level II LNs:

Answer 11

Superior: skull base

Inferior: inferior border of hyoid bone

Anterior (medial)l:
- clinical - stylohyoid muscles
radiologic - vertical plane defined by posterior surface of the submandibular gland.

Posterior (lateral))

Question 12

Sublevel II A vs. II B: how to differentiate

Answer 12

vertical plane defined by the spinal accessory nerve.

Question 13

Boundaries of level III:

Answer 13

SUPERIOR:
Inferior aspect of the hyoid bone (clinical and radiologic); surgical landmark - carotid bifurcation

INFERIOR:
lower border of cricoid cartilage; surgical landmark - junction of omohyoid muscle with he IJV

LATERAL: posterior border of SCM

MEDIAL:
lateral border of the sternohyoid; (radiologic) - lateral borded of common carotid artery

Question 14

Corresponding areas which may harbor metastasis: Level V

Answer 14

Nasopharynx, oropharynx

Cutaneous structures of scalp and neck

Question 15

Corresponding areas which may harbor metastasis: Level IA

Answer 15

Floor of mouth
Anterior Oral tongue
Anterior mandibular alveolar ridge
Lower lip

Question 16

Corresponding areas which may harbor metastasis: Level IA

Answer 16

Oral cavity
Anterior nasal cavity
Soft tissue structures of midface
Submandibular gland

Question 17

Corresponding areas which may harbor metastasis: Level II A and II B

Answer 17

nasal cavity
nasopharynx,
oral cavity
oropharynx, hypopharynx, larynx

parotid

Question 18

Corresponding areas which may harbor metastasis: Level III

Answer 18

oral cavity

oropharynx, nasopharynx, hypopharynx, larynx

Question 19

Corresponding areas which may harbor metastasis: Level IV

Answer 19

Larynx

Hypopharynx

Esophagus

Thyroid

Question 20

Corresponding areas which may harbor metastasis: Level V

Answer 20

Nasopharynx, oropharynx

Cutaneous structures of scalp and neck

Question 21

Boundaries of level V:

What separates VA and VB?

Answer 21

SUPERIOR: Apex formed by the convergence of the SCM and Trapezius Muscles

INFERIOR: CLAVICLE

ANTERIOR:
Posterior border of the SCM

POSTERIOR: Anterior border of the trapezius

Question 22

Boundaries of level VI:

Answer 22

SUPERIOR: Hyoid bone

INFERIOR: Suprasternal notch

LATERAL: Common carotid arteries

Question 23

Corresponding areas which may harbor metastasis: Level V

Answer 23

Apex of pyriform sinus

Glottic, subglottic larynx

cervical esophagus

Thyroid gland