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C H A P T E R 2 | Oncologic Components of Lymphadenectomy

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Hyoid bone

External branch of superior laryngeal nerve

Common carotid artery

Common carotid artery

Parathyroid glands

VI

Recurrent laryngeal nerve

Thymus

VII

FIGURE 2-3  Central neck. Roman numbers indicate levels.

the thyroid, the pretracheal lymph nodes inferior to the thyroid isthmus, and the prelaryngeal (Delphian) lymph node(s) just superior to the thyroid isthmus (Fig. 2-4). The majority of the level VI lymph nodes are located inferior to the cricoid cartilage and posterior and inferior to the thyroid gland. The RLN can be situated anterior or posterior to involved central compartment lymph nodes, and care should be taken to examine behind the RLN to avoid missing lymph node metastasis, particularly on

Delphian node

Preserved superior parathyroid gland Left RLN

Metastatic lymph nodes Preserved superior parathyroid gland Right RLN

Metastatic lymph nodes

FIGURE 2-4  Central compartment neck dissection after thyroidectomy. Dotted lines mark the border of the central neck dissection. Note Delphian node preserved superior parathyroid glands, bilateral recurrent laryngeal nerves, and metastatic lymph nodes. RLN, recurrent laryngeal nerve.