Topographical analysis of lymphatic pathways from the meso- and hypopharynx based on minute cadaveric dissections: possible application to neck dissection in pharyngeal cancer surgery

Abstract

To facilitate the development of new operative procedures for pharyngeal cancer, it is important to understand the precise location of the lymph nodes and their pathways. Minute dissection of 22 neck-halves (11 adult cadavers) was undertaken to determine the location and topographical relationships of the lymphatics of the pharynx. Four groups of lymph nodes on the drainage pathways from the meso- and hypopharynx to the internal jugular nodes were classified according to their topographical relationships to the carotid arteries: lateral pharyngeal, superior thyroid, lateral retropharyngeal and medial retropharyngeal nodes. Lymphatics from the mesopharynx passed laterally to lateral pharyngeal or jugulodigastric nodes or slightly upward to lateral retropharyngeal nodes. Lymphatic drainage from the hypopharynx was multidirectional with the pathways being classified as follows: ascending pathway to the lateral pharyngeal and lateral retropharyngeal nodes, lateral pathway to the internal jugular chain, and descending pathway connecting to the uppermost vessels ascending from the recurrent laryngeal nerve chain. In addition, a contralateral pathway was found originating from the hypopharynx extending to the contralateral internal jugular chain. These findings provide valuable information for comparison with CT and MRI studies, as well as with clinicopathological data, to clarify the precise mode of metastasis in head and neck cancers. These results are also applicable to neck dissection in meso- and hypopharyngeal cancers.

Distribution and impact of lymph node metastases in oropharyngeal cancer

“…The present study also demonstrated that metastases to RPLNs were observed not only in advanced cancers but also in early cancers, further supporting the idea that RPLNs are the echelon nodes of the oropharyngeal walls [24], as Rouviere discussed [25]. It has been our policy to recommend postoperative radiotherapy to patients with three or more lymph node metastases or ECS.…”

Ultrasonography and noncontrast computed tomography of medial retropharyngeal lymph nodes in healthy cats

“…Six of 45 cats screened for inclusion in the study were excluded because of positive results for FIV (n = 1) or FeLV (1), heart murmur detected via physical examination (1), or patient noncompliance at the time of collection of blood samples for hematologic analysis (3). Thirty-nine cats underwent CT and ultrasonography.…”

Lymphatic drainage of the nasal fossae and nasopharynx: Preliminary anatomical and radiological study with clinical implications

“…The lymphatic vessels draining the nasal fossae to the retropharyngeal lymph nodes, known as Rouvière nodes, have been discussed in previous studies 1–10. But in these articles, the lymphatic flow was not directly observed.…”

“…Previous anatomical studies show only schematic diagrams1–5 that vary from this study. The lymphatic relationship between the wall of the nasal cavity and the pharynx remains unclear although the lymph pathways of the parapharynx have been demonstrated based on a series of human cadaveric dissections 6. Clinical reports show how important this area is, but the main emphasis has been on the nodes 7–10.…”