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

Abstract

Background. The lymphatic pathways of the nasal cavity are of enormous clinical importance. To date there has been no accurate radiographic record of these pathways.Methods. Four halves of the head and neck from 2 fresh human cadavers were studied.Results. The capillary network arises from the mucous membrane of the atrium, the turbinates, the floor of the nasal cavity, and the nasopharynx. They drain into the lateral pharyngeal and retropharyngeal lymph nodes. There is 1 lymphatic communication at the junction of the lateral posterior wall of the turbinates and the nasopharynx and another communication between 2 groups of lymph nodes situated between the origin of the facial artery and the bifurcation of the carotid artery.Conclusions. A rich avalvular lymph capillary network exists in the mucous membrane and 2 major lymph collecting vessels course through the parapharyngeal space to multiple first tier lymph nodes. It is essential to understand the actual lymphatic pathways of the nasal cavity and pharynx when treating patients with cancer. Previous anatomical studies show only schematic diagrams 1-5 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][8][9][10] Lymphoscintigraphy is an efficient procedure for sentinel lymph node biopsy in melanoma patients, 11,12 but lymphatic drainage of the nasal cavity and nasopharynx to first tier lymph nodes requires further study. 13 In this study, we demonstrate the lymphatic drainage of the nasal fossae and nasopharynx with photographic and radiographic images showing the initial lymph network (that includes capillary network and precollectors) in the mucous membrane of the nasal fossae walls and the nasopharynx, the lymph collectors, and the lymph nodes in the parapharyngeal space. These results add to our anatomical knowledge and will help

A risk score model for the metastasis of level Ib lymph node based on the clinicopathological features of nasopharyngeal carcinoma in a large sample

“…These risk factors could be interpreted by lymphotomy. In general, the metastasis of lymph nodes in NPC is characterized by systematic spreading down the neck along the deep cervical lymph nodes (6,22). The level Ib lymph nodes are superficial cervical lymph nodes and they drain the lymph from the floor of the mouth, buccal mucosa, gingiva, face and anterior region of the orbit and nasal cavity to the deep cervical lymph nodes.…”

“…The retropharyngeal lymph nodes are the first echo node of the NPC (6,22), which is regarded as an indicator of neck metastasis. Certain studies have indicated that carotid sheath involvement is the transfer station for neck metastasis (23).…”

Unusual Metastatic Site For Nasopharynx Carcinoma: A Case Report

“…Pan et al demonstrated the lymphatic drainage of the nasal fossa and nasopharynx as the initial lymphatics in the nasal fossa and nasopharynx, the collector lymphatics in the parapharangeal space and the lymph nodes in the lateral pharyngeal and retropharyngeal area (6). Our patient presented with right axillary and cervical LAPs and relapsed with mild cervical and large axillary LAPs after asymptomatic two years.…”

“…Nasopharyngeal thickenening with high uptake on 18-F-PET-CT was determined while evaluating the patient for axillary and cervical LAPs. Right axillary lymphatic region is not defined among the primary lymphatic drainage regions of nasopharynx (6). So, nasopharynx carcinoma is not a common cause of right axillary LAP.…”

“…Nasopharyngeal carcinoma is commonly metastasis to bone (75%), liver, lung and distant lymph nodes (5). Axillary lymph nodes are not among the primary lymphatic stations for nasopharyngeal carcinoma (6). A male patient with axillary LAP besides other metastasis and nasopharynx carcinoma is presented in this report.…”