Clinical anatomy - neck Jan Plzák Department of Otorhinolaryngology and Head and Neck Surgery Institute of Anatomy 1st Faculty of Medicine, Charles Univesity, Prague
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