Clinical anatomy - neck

Jan Plzák

Department of Otorhinolaryngology and Headand Neck Surgery

Institute of Anatomy

1st Faculty of Medicine, Charles Univesity, Prague

Head and necks squamous cancer

oropharynx, larynx, …

Lymph node metastasis is the most important prognostic factor

Classification of neck lymph nodes

Neck dissection

Systematic removal of necklymph nodes (+ non-lymphatic structures: SMG, SCM, IJV, AN, etc)

Clearly defined anatomicalborders - compartments

Classification of ND

Radical: I-V + SCM+IJV+N XI

Modified: I-V with preservation of non-lymphaticstructures (N XI, IJV, SCM)

Selective: preservation of some level

Extended: + resection of other non-lymphaticstructure

R. MARGINALIS N. FACIALIS

R. MARGINALIS N. FACIALIS

N. HYPOGLOSSUS

N. LINGUALIS

PL. CERVICALIS

V. JUGULARIS EXTERNA

M. STERNOCLEIDOMASTOIDEUS

V. JUGULARIS INTERNA

N. ACCESSORIUS

INFRAHYOID MUSCLES

A. CAROTIS

N. VAGUS

PLEXUS CERVICALIS

N. PHRENICUS

DEEP CERVICAL MUSCLES

DUCTUS THORACICUS

TRUNCUS SYMPATHICUS

PLEXUS BRACHIALISVASA TRANSVERSA COLLI

TRACHEOTOMIA

- skin- subcutaneous tissue

TRACHEOTOMIA

- fascia colli superficialis

- vv. jugulares anteriores- arcus venosus juguli

TRACHEOTOMIA

- fascia colli media - mm. infrahyoidei/linea alba

TRACHEOTOMIA

- isthmus gl. thyroideae/lobus pyramidalis

- vv. thyroideae inferiores- nodi lymphatici pretracheales- thymus- a. thyroidea ima

ISTHMUS GL. THYROIDAEET LOBUS PYRAMIDALIS

VV. THYROIDEAE

plexus thyroideus impar

A. THYROIDEA IMA

N. LARYNGEUS RECURRENS

(Work and Hybels. Laryngoscope 1974;84:1748-1755.)

Parapharyngeal space

Pre- and retrostyloid compartment

nasopharynx oropharynx

MRI - Pleomorfic adenoma

T2WT1W T1WGD

CT/MRI - Schwannoma

T1WGD

T1W

T2W

CT

MRI - Paraganglioma

T1W T1W-Gd T2W

Giemsa

T1W T1WT1W-Gd

T2W T1W-GdT1W

MRI+FNA-C:pleomorfic adenoma of small salivary gland

M 17 yearsancylostoma, pain for 1 month

TE, - bleeding

TO-TC APPROACH

CCA

IJV

N XII

N XI

SMŽ

TO-TC APPROACH

1

pleomorfic adenomaHE

TO-TC APPROACH