2. CERVICAL METASTASES CERVICAL METASTASES Assessment of a neck mass Assessment of a neck mass M. Hosseini M.D. M. Hosseini M.D. Head & Neck Surgeon Head & Neck Surgeon Rasool Akram Hospital Rasool Akram Hospital Iran University Iran University Assessment of a neck mass Assessment of a neck mass M. Hosseini M.D. M. Hosseini M.D. Head & Neck Surgeon Head & Neck Surgeon Rasool Akram Hospital Rasool Akram Hospital Iran University Iran University

3. L. N. Occipital Postauricular Preauricular Parotid Facial A.N. Occipital Postauricular Preauricular Parotid Facial A.N. Nomber 1 - 3 2 2 2 6 - 8 1 1 Infraorbital (maxillary) Buccinator Supramandibular Submandibular Submental (Suprahyoid) Internal jugular Spinal accessory Transverse Infraorbital (maxillary) Buccinator Supramandibular Submandibular Submental (Suprahyoid) Internal jugular Spinal accessory Transverse 5 - 8 3 - 6 2 - 3 10 - 20 20 4 - 12

5. Drainage patterns - Lymphatic flow change in the neoplastic & postsurgical state. postsurgical state. - Lymphatic flow change in the neoplastic & postsurgical state. postsurgical state.

6. Parotid node : - Root of the nose - Eyelids - Frontotemoral skin - External auditory meatas - Tympanic cavity - Root of the nose - Eyelids - Frontotemoral skin - External auditory meatas - Tympanic cavity

7. Preauricular (superficial parotid N.) : - Anterior (Lateral) of auricle - Skin of the adjacent temporal region - Anterior (Lateral) of auricle - Skin of the adjacent temporal region

8. Postauricular N. (mastoid) - Postauricular area - Posterior aspects of the pinna - External auditory canal - Postauricular area - Posterior aspects of the pinna - External auditory canal

9. Occipital node : Scalp over the occipital portion Of the skull Scalp over the occipital portion Of the skull

10. Submandibular nodes : - Side & vestibular aspect of the nose - Upper Lip - The most lateral part of the lower lip - The gums - The anterior aspect of the tongue margin - Part of the lateral floor of mouth - Side & vestibular aspect of the nose - Upper Lip - The most lateral part of the lower lip - The gums - The anterior aspect of the tongue margin - Part of the lateral floor of mouth

11. Superior deep jugular nodes : - Soft palate - Palatine tonsil & pillars - Posterior oral tongue - Tongue base - Piriform sinuses - Supraglottic larynx - Retropharyngeal - Spinal accessory - Parotid - Superficial cervical - Submandibular - Soft palate - Palatine tonsil & pillars - Posterior oral tongue - Tongue base - Piriform sinuses - Supraglottic larynx - Retropharyngeal - Spinal accessory - Parotid - Superficial cervical - Submandibular

12. Middle deep cervical nodes : - Supraglottic Larynx - Lower piriform sinus - Posterior cricoid area - Inferior retropharyngeal nodes - Superior jugular nodes - Supraglottic Larynx - Lower piriform sinus - Posterior cricoid area - Inferior retropharyngeal nodes - Superior jugular nodes

13. Spinal Accessory nodes - Parietal & occipital regions of the scalp - Upper retropharyngeal & Parapharyngeal nodes draining the nasopharynx & paranasal nodes draining the nasopharynx & paranasal sinuses. sinuses. - More cephalic spinal accessory nodes drain into the superior deep cervical nodes, into the superior deep cervical nodes, whereas the more inferior have connection whereas the more inferior have connection with supraclavicular with supraclavicular - Parietal & occipital regions of the scalp - Upper retropharyngeal & Parapharyngeal nodes draining the nasopharynx & paranasal nodes draining the nasopharynx & paranasal sinuses. sinuses. - More cephalic spinal accessory nodes drain into the superior deep cervical nodes, into the superior deep cervical nodes, whereas the more inferior have connection whereas the more inferior have connection with supraclavicular with supraclavicular

14. Supraclavicular : - Metastases from infraclavicular primary tumors - Cervical esophagus - Thyroid - Nasopharynx (rare) - Metastases from infraclavicular primary tumors - Cervical esophagus - Thyroid - Nasopharynx (rare)

15. Nasopharynx & piriform sinuses have the most Profuse networks of capillary lymphatics, Whereas the paranasal sinus, midlle ear & True vocal cords have minimal or no lymphatics. Nasopharynx & piriform sinuses have the most Profuse networks of capillary lymphatics, Whereas the paranasal sinus, midlle ear & True vocal cords have minimal or no lymphatics.

16. Metastases from an unknown primary malignancy - Lymph nodes contain metastatic S.C.C. %90 in the H & N. the H & N. - Nasopharynx, hypopharynx, esophagus, Larynx, tracheobronchial tracheobronchial - Malignant melanoma in cervical L.N. (previous skin Lesions – scalp nose – oral cavity – sinus – Lesions – scalp nose – oral cavity – sinus – ophthalmologic exam.) ophthalmologic exam.) - Metastatic adenocar. Salivary glands – thyroid – breast – Gi tract – genitourinary tract – pelvic tumors – prostate breast – Gi tract – genitourinary tract – pelvic tumors – prostate - Lymph nodes contain metastatic S.C.C. %90 in the H & N. the H & N. - Nasopharynx, hypopharynx, esophagus, Larynx, tracheobronchial tracheobronchial - Malignant melanoma in cervical L.N. (previous skin Lesions – scalp nose – oral cavity – sinus – Lesions – scalp nose – oral cavity – sinus – ophthalmologic exam.) ophthalmologic exam.) - Metastatic adenocar. Salivary glands – thyroid – breast – Gi tract – genitourinary tract – pelvic tumors – prostate breast – Gi tract – genitourinary tract – pelvic tumors – prostate