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Facial anatomy
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
The neck contains some 300 lymph nodes, the two most important groups to know are the submental and submandibular nodes, to which a large proportion of lymphatics in the head drain: Submental lymph nodes: These are found under the chin between the two anterior bellies of the digastric muscles. Afferent drainage is from the lower lip, floor of the mouth and the tip of the tongue; afferent drainage is split between the submandibular lymph nodes and the deep cervical lymph nodes.Submandibular lymph nodes: These nodes are located beneath the mandible within the submandibular triangle. Their afferent drainage comes the cheeks, lateral nose, lips, gums and part of the tongue; it includes efferent drainage from the submental and many of the facial lymph nodes. Their efferent drainage is to the deep cervical lymph nodes.
Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
Lastly, the contents of the submental triangle of the neck are the submental lymph nodes and the boundaries of this triangle are: lateral, the right and left anterior digastric muscles; inferior, the hyoid bone; superficial (roof), the investing layer of deep cervical fascia; and deep, the mylohyoid muscle (Plate 3.25).
Surgical Anatomy of the Neck
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Laura Warner, Christopher Jennings, John C. Watkinson
This nodal area is a single midline zone, corresponding to the submental triangle, between the two anterior bellies of digastric and the hyoid bone. The submental lymph nodes are located within this level, which provides lymphatic drainage to the anterior floor of mouth, lower lip and ventral tongue.
A case of primary central nervous system lymphoma presenting as a shunt complication
Published in British Journal of Neurosurgery, 2023
Roberto J. Perez-Roman, Zachary S. Hubbard, G. Damian Brusko, Robert M. Starke
CSF fluid was collected from the shunt and sent for cytology, which revealed CD45+ cells concerning for malignancy. A CT scan of the chest was performed due to concern for possible pulmonary embolus and revealed bilateral lobar filling defects which led to IVC filter placement. Moreover, the CT revealed prominent left axillary and submental lymph nodes. These were evaluated, biopsied by otolaryngology, and determined to be negative for malignancy. Because of uncertainty of the pathology, we proceeded with an endoscopic brain biopsy of the lesion within the lateral ventricles (Figure 3). The immediate postoperative period was uneventful. Patient’s family consented via telephone to discussion of case details.
Management of periocular cutaneous squamous cell carcinoma with perineural invasion: a case series and literature review
Published in Orbit, 2022
Thomas J. E. Clark, Gerald J. Harris
A 73-year-old man was referred to the MCW Orbital and Oculofacial Plastic Surgery Clinic with a 14-month history of a right lower eyelid and medial cheek lesion, found to be SCC on recent biopsy (Figure 2A). Medical history was significant for hyperlipidemia, reactive airway disease, and pre-diabetes mellitus. There was no history of immunosuppression. A recent fine-needle aspiration biopsy of a palpable submental lymph node had been inconclusive. On palpation, the infraorbital skin lesion did not appear adherent to underlying periosteum or bone, and there was no hypesthesia or dysesthesia in the V2 dermatomal distribution. The patient underwent 2-stage Mohs excision with a resulting 3.5 × 2.5 cm defect extending deeply through orbital septum and to periosteum over the inferior orbital rim and anterosuperior maxilla (Figure 2B). The stage-1 Mohs specimen showed moderately differentiated SCC with PNI (greatest nerve diameter, 0.13 mm) (Figure 2C). Stage-2 sections showed no residual tumor or PNI. Following confirmation of an intact lacrimal drainage apparatus, reconstruction involved an advancement lower eyelid/cheek flap anchored at the periosteum of the lateral orbital rim and medial canthal tendon, advancement of the nasal sidewall to periosteum, and a modified medial canthopexy. At postoperative week 7, the advancement flap was healthy and mild medial ectropion was seen (Figure 2D). In consideration of the PNI and other high-risk features (size >2 cm; depth of invasion), adjuvant RT, MRI, and further evaluation of lymph node status were recommended. Adjuvant RT consisted of superficial photons to a total dose of 5000 cGy in 20 fractions (postoperative weeks 6–11). One week after completion, there was severe radiation dermatitis with retraction and ectropion (Figure 2E). At postoperative week 14, right neck dissection revealed 9 of 47 nodes positive for SCC, with several demonstrating extracapsular extension. Full-body MRI was negative for distance metastasis. The AJCC stage was T3N3bcM0. He was subsequently treated with RT to the neck and transit lymphatics (6600 cGy, 33 fractions) and with concurrent systemic cisplatin (100 mg/m2 on days 1, 22, and 43 of RT). At week 17, radiation dermatitis of the primary site had largely resolved with lessened contracture and only mild residual ectropion (Figure 2F). At medical and radiation oncology follow-up in postoperative months 8 and 17, 10 and 19 months after presentation, there was no sign of regional or systemic SCC recurrence. PET imaging 3 months prior showed no sign of disease.