Neck, Including Uknown Primary (under construction) Flashcards
Neck
Identify the group/level/chain of lymph nodes described:
lie adjacent to the internal
jugular vein and extend from the skull base to the clavicle
IJ chain
Neck
Identify the group/level/chain of lymph nodes described:
most superior portion of the IJC chain, lie near the base of the skull in the posterior
aspect of the lateral pharyngeal space
parapharyngeal or junctional lymph nodes
Neck
Identify the group/level/chain of lymph nodes described:
lymph nodes are distributed along the
course of cranial nerve XI
Spinal accessory chain
Neck
The superior nodes of the SAC blend with the upper IJC nodes.
What lymph nodes merge laterally and medially with the SAC inferiorly?
supraclavicular (l) lower IJC (m)
Neck
How many lymph nodes are typically found in the submandibular area?
3-6
Neck
How many lymph nodes are typically found in the submental area?
1-3
Neck
There are no lymph nodes in the substance
of the submandibular gland.
TRUE or FALSE?
True.
They are either pre or post glandular
Neck
Identify the group/level/chain of lymph nodes described:
lie next to the facial artery and vein around the marginal mandibular nerve
perifacial lymph nodes.
Neck
Identify the group/level/chain of lymph nodes described:
lie between the anterior bellies of the digastric muscle and anterior and superior to the hyoid bone, and superficial to the mylohyoid muscle.
submental nodes.
Neck
Identify the group/level/chain of lymph nodes described:
bounded anteriorly by the pharyngeal constrictors, superiorly by the skull base, and posteriorly by the prevertebral fascia.
usually at the level of C1-2 (or 3)
lateral RPN.
***
The medial retropharyngeal nodes are small, inconstant
intercalated nodes that are located near midline and empty into the lateral
retropharyngeal lymph nodes
Neck
Identify the group/level/chain of lymph nodes described:
from the skull base to the level of the hyoid bone divided by the spinal accessory nerve into
a (anterior to the nerve) and b (posterior to the nerve)
level II (upper IJ nodes)
Neck
Identify the group/level/chain of lymph nodes described:
bounded by the hyoid bone, the sternum, and the common carotid arteries
level VI (central neck nodes)
Neck
Identify the group/level/chain of lymph nodes described:
from the level of the omohyoid muscle to the clavicle
level IV (inferior IJ nodes)
Neck
What nodes are included in level VI?
paralaryngeal
pretracheal
precricoid (delphian)
tracheoesophageal groove nodes
Neck
In general, what influence the risk of lymph node metastases?
location of T
size of T
histologic differentiation
availability of capillary lymphatics
Neck
What sites are automatically considered high-risk of harboring subclinical neck disease (>30%) based on site, regardless of T-stage?
nasopharynx, pyriform sinus, base of tongue
Neck
What sites are considered low risk of harboring subclinical neck disease (<20%) if T1, intermediate risk (20–30%) if T2, and high-risk if T3–4(>30%)?
floor of mouth retromolar gingiva trigone buccal mucosa hard palate
Neck
In general, what is the most common involved group of lymph nodes?
ipsilateral level II
Neck
In general, aside from midline lesions, what sites with well-lateralized tumors have a propensity to spread bilaterally?
nasopharynx
base of tongue
Neck
In general, patients who have clinically + ipsilateral nodes have a risk of contralateral spread due to obstruction of lymphatic trunks.
What extrinsic factor may also contribute to shunting of lymph across the submental region to the opposite side of the neck?
previous neck surgery.
Neck
In general, what is the most common involved group of lymph nodes on the contralateral side?
II
Neck
Which of the statements regarding PE is/are FALSE?
I. The patient is examined in the sitting position, the examiner behind the patient with one hand on the occiput to flex the patient’s head FORWARD and the other hand on the side of the neck to be examined.
II. To examine the IJC lymph nodes, which lie deep to the sternocleidomastoid muscle along the internal jugular vein, place the thumb and index finger around the sternocleidomastoid muscle in the form of a “C,” and then, gently proceed FROM the sternal notch TO the angle of the mandible.
III. Both sides of the neck should NOT be examined simultaneously.
IV. The level Ib and level Ia nodes may be evaluated by direct palpation of these areas as well as by a bimanual examination with the index finger placed in the floor of the mouth.
None.
ALL statements are lifted directly from the book.
p.3456
Neck
Extension to neurovascular
bundles causes this PE finding.
fixed to palpation
Neck
Tumor size is related the likelihood of capsular penetration.
TRUE or FALSE?
True
Neck
Review of the 2017 AJCC staging for neck nodes:
a. ENE+
b. ipsilateral <3
c. ipsilateral >3 <6
d. bilateral
e. contralateral
f. multiple ipsilateral <6
a. n3b
b. n1
c. n2a
d. n2c
e. n2c
f. n2b
Neck
What structures are removed in a “radical” neck dissection?
lymph nodes levels I to V
IJV
SCM
spinal accessory nerve
Neck
What structures are removed in a “modified radical” neck dissection?
lymph nodes levels I to V
with preservation of at least one of the non lymphatic structures removed in a radical procedure
(IJV
SCM
spinal accessory nerve)
Neck
Patients with lesions arising in these sites ______ have a low risk of subclinical neck
disease, and the neck is not treated electively unless the lesion is recurrent,
advanced, or poorly differentiated.
lip,
nasal vestibule,
nasal cavity, or paranasal sinuses
T1-2 glottic
Neck
Total RT dose for clinically positive nodes when a post RT neck dissection is “not” planned?
at least 70 Gy
Neck
Biopsy of the neck nodes prior to definitive treatment “may” “potentially” cause neck control failure that may not be removed by an RND.
TRUE or FALSE?
True
Neck
When using conventional lateral opposed fields, how can you minimize the risk of fibrosis and lymphedema at the submentum?
sparing an anterior strip of skin
Neck
Prognostic factors (in order of importance) for predicting the time to occurrence.
Neck recurrence
- Increasing N-stage
- Treatment of the neck with RT alone
- Fixed nodes
- T-stage
Neck
Prognostic factors (in order of importance) for predicting the time to occurrence.
Death with disease present
- Recurrence above clavicles
- Increasing N stage
- Fixed nodes
- Treatment of neck with RT alone
Neck
Prognostic factors (in order of importance) for predicting the time to occurrence.
Distant metastasis
- Recurrence above clavicles.
- Increasing N stage
- Fixed nodes
- Nodes below the thyroid notch
Unknown Primary (Neck)
Patients with enlarged lymph nodes in the upper neck have a good prognosis when treated aggressively, compared with those with enlarged lymph nodes in the low internal jugular chain or supraclavicular fossa.
TRUE or FALSE?
True
