58:
46:
606:
594:
120:
577:
and may be associated with a halving of survival. Where the cancer has penetrated the capsule of the lymph gland (extracapsular extension) survival may be decreased by a further 50%. Other important factors are the level, the number of nodes and their size, which are also correlated with the risk of
247:
However, this system was based upon anatomical landmarks found in dissection, making it imperfectly suited to the needs of clinicians, which led to new terminology for the lymph nodes that could be palpated. The most commonly used system is one based on a classification of the lymph nodes into
486:
Level VA: Apex of the convergence of the sternocleidomastoid and trapezius muscles, Horizontal plane defined by the lower border of the cricoid cartilage, Posterior border of the sternocleidomastoid muscle or sensory branches of cervical plexus, Anterior border of the trapezius
519:
While an imaging based system was proposed in 1999, these concepts were integrated into the 2002 revision of the
American Academy system. In addition to needing a standardised approach to classification of lymph nodes for the purposes of neck dissection, the application of
475:
Level III: Horizontal plane defined by the inferior body of hyoid, Horizontal plane defined by the inferior border of the cricoid cartilage, Lateral border of the sternohyoid muscle, Lateral border of the sternocleidomastoid or sensory branches of
1190:
Robbins, K. T.; Medina, J. E.; Wolfe, G. T.; Levine, P. A.; Sessions, R. B.; Pruet, C. W. (1 June 1991). "Standardizing Neck
Dissection Terminology: Official Report of the Academy's Committee for Head and Neck Surgery and Oncology".
244:, consisting of submental, facial, submandibular, parotid, mastoid, occipital and retropharyngeal nodes, together with two chains that run in the long axis of the neck, the anterior cervical and postero-lateral cervical groups.
455:
rather than cervical nodes, and therefore should not be included in the classification of neck nodes. However it is based on the 2002 American
Academy system, although the boundaries are defined slightly differently.
482:
Level IV: Horizontal plane defined by the inferior border of the cricoid cartilage, Clavicle, Lateral border of the sternohyoid muscle, Lateral border of the sternocleidomastoid or sensory branches of cervical
268:
More recently, classification systems have been proposed organized around what can be observed via diagnostic imaging. In addition to the
American Academy of Otolaryngology, systems have been devised by the
1094:
Grégoire, Vincent; Ang, KianA. (January 2014). "Delineation of the neck node levels for head and neck tumors: A 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines".
1308:
Som, Peter M.; Curtin, Hugh D.; Mancuso, Anthony A. (1 April 1999). "An
Imaging-Based Classification for the Cervical Nodes Designed as an Adjunct to Recent Clinically Based Nodal Classifications".
472:
Level IIB: Skull base, Horizontal plane defined by the inferior body of the hyoid bone, Vertical plane defined by the spinal accessory nerve, Lateral border of the sternocleidomastoid muscle
1222:
Robbins, K. Thomas; Clayman, Garry; Levine, Paul A.; Medina, Jesus; Sessions, Roy; Shaha, Ashok; Som, Peter; Wolf, Gregory T. (1 July 2002). "Neck
Dissection Classification Update".
490:
Level VB: Horizontal plane defined by the lower border of the cricoid cartilage, Clavicle, Posterior border of the sternocleidomastoid muscle, Anterior border of the trapezius muscle
404:, and inferiorly by the clavicle. The anteromedial border is the posterior border of the sternocleidomastoid and the posterolateral border is the anterior border of the trapezius.
937:
469:
Level IIA: Skull base, Horizontal plane defined by the inferior border of the hyoid bone, The stylohyoid muscle, Vertical plane defined by the spinal accessory nerve
451:
The
American Joint Committee on Cancer (AJCC) system differs from the above by including Level VII, but the American Academy considered these to be anatomically
904:
1310:
1224:
208:. Of the 800 lymph nodes in the human body, 300 are in the neck. Cervical lymph nodes are subject to a number of different pathological conditions including
1424:
1034:
463:
Level IA: Symphysis of mandible, Body of hyoid, Anterior belly of contralateral digastric muscle, Anterior belly of ipsilateral digastric muscle
240:
in his 1932 publication "Anatomie des
Lymphatiques de l'Homme" Rouviere described the cervical lymph nodes as a collar which surrounded the
1285:
1577:
1389:
2096:
1582:
389:, anteromedially by the lateral border of the sternohyoid and posterolaterally by the posterior border of the sternocleidomastoid.
1497:
1492:
1147:
Park, Chang Ho; Song, Chang Myeon; Ji, Yong Bae; Pyo, Ju Yeon; Yi, Ki Jong; Song, Young Soo; Park, Yong Wook; Tae, Kyung (2015).
1417:
915:
249:
1487:
1051:
856:
370:- around the middle third of the internal jugular vein, from the inferior border of the hyoid to the inferior border of the
273:(AJCC). The AJCC system from the 7th edition of the Staging Manual (2009) remains unchanged in the 8th edition of 2018.
1822:
1637:
1632:
1600:
1124:
872:
270:
253:
919:
466:
Level IB: Body of mandible, Posterior belly of digastric muscle, Anterior belly of digastric muscle, Stylohyoid muscle
1627:
1410:
848:
2068:
1742:
1569:
1043:
414:
Level VB: Lymph nodes below this plane, including the transverse cervical nodes and supraclavicular nodes (except
1964:
1948:
1477:
868:"The size of lymph nodes in the neck on sonograms as a radiologic criterion for metastasis: how reliable is it?"
1880:
1062:
228:
There are approximately 300 lymph nodes in the neck, and they can be classified in a number of different ways.
1737:
1670:
1842:
1837:
1832:
1827:
1675:
1348:
2001:
1680:
1642:
579:
397:
566:(which has a high rate of accuracy), may also be required. Involvement of the cervical lymph nodes with
1989:
1984:
1762:
1652:
1647:
1193:
393:
348:
62:
Cervical lymph node levels (American
Academy of Otolaryngology system from 2002), and superficial nodes
24:
2056:
1767:
1592:
1539:
436:
385:- around the lower third of the internal jugular vein from the inferior border of the cricoid to the
343:
and the lower boundary is the inferior border of the hyoid bone. The anterior/medial boundary is the
1979:
1847:
1615:
1610:
1482:
1149:"Significance of the Extracapsular Spread of Metastatic Lymph Nodes in Papillary Thyroid Carcinoma"
532:
428:
1911:
1817:
1812:
1605:
574:
444:
424:
351:. On imaging the anterior/medial boundary is the vertical plane of the posterior surface of the
524:
also requires such an approach and has resulted in an international consensus guideline (2013).
392:
Level V: Posterior triangle nodes - around the lower half of the spinal accessory nerve and the
2026:
1969:
1916:
1785:
563:
311:
102:
605:
2075:
1546:
1534:
1527:
1522:
1462:
408:
332:
296:
286:
2051:
1921:
1875:
1852:
1732:
1727:
1369:
571:
367:
28:
400:. The upper boundary is the apex formed by the convergence of the sternocleidomastoid and
8:
1941:
1936:
1931:
1747:
1700:
1620:
1472:
1467:
1206:
593:
513:
432:
382:
352:
328:
241:
2021:
1996:
1926:
1752:
1517:
1275:
1249:
1173:
1148:
1016:
991:
973:
946:
886:
867:
551:
440:
375:
290:
493:
Level VI: Hyoid bone, Suprasternal notch, Common carotid artery, Common carotid artery
2061:
1327:
1298:
1241:
1210:
1178:
1111:
1082:
1047:
1021:
978:
891:
852:
521:
497:
415:
371:
344:
340:
315:
300:
237:
1434:
1319:
1294:
1253:
1233:
1202:
1168:
1160:
1103:
1074:
1011:
1003:
968:
958:
881:
459:
The boundaries are defined as (Superior, Inferior, Antero-medial, Postero-lateral)
401:
281:
The
American Academy of Otolaryngology system (2002) divides the nodes as follows:
78:
1402:
260:
that was updated in 2002, including the addition of sub-levels, e.g. IIA and IIB.
57:
1265:
1107:
916:
Department of Otolaryngology, The University of Texas Medical Branch at Galveston
842:
555:
477:
336:
257:
1007:
2031:
1323:
1261:
1237:
578:
distant metastases. Cervical lymph node metastasis is also a common feature of
538:
affects the cervical lymph nodes which become swollen. The characterization of
1078:
963:
2090:
1870:
1164:
1272:
Anatomy of the Human Lymphatic System, Edwards Brothers, Ann Arbor, MI. 1938
1132:
1331:
1245:
1182:
1115:
1086:
1025:
982:
314:- within the boundaries of the anterior belly of the digastric muscle, the
217:
73:
1214:
947:"Lymph node ratio as a prognostic factor in head and neck cancer patients"
895:
407:
Level VA: Above the horizontal plane formed by the inferior border of the
236:
The classification of the cervical lymph nodes is generally attributed to
452:
378:
and postero-laterally by the posterior border of the sternocleidomastoid.
256:
published a standardised version of thisto provide a uniform approach to
841:
Amin, Mahul B.; Edge, Stephen B.; Greene, Frederick L. (30 March 2018).
19:
This article is about lymph nodes in the neck. For lymph nodes near the
567:
201:
108:
509:
358:
Level IIa: Anteromedial to the vertical plane of the accessory nerve.
213:
119:
45:
1033:
Edge, Stephen; Byrd, David R.; Compton, Carolyn C. (28 April 2011).
1394:
945:
Chen, Chien-Chih; Lin, Jin-Ching; Chen, Kuan-Wen (25 August 2015).
559:
386:
319:
252:
in the 1930s. This has been variously modified since. In 1991, the
209:
1036:
AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual
543:
505:
501:
374:. Antero-medially they are bounded by the lateral border of the
539:
20:
688:
347:
and the posterior/lateral one is the posterior border of the
304:
90:
866:
van den Brekel, MW; Castelijns, JA; Snow, GB (April 1998).
648:
646:
644:
642:
640:
205:
992:"Cervical lymphadenopathy: what radiologists need to know"
794:
663:
661:
570:
cancer is the single most important prognostic factor in
554:
is difficult, and usually requires confirmation by other
547:
435:(Delphian) and perithyroid nodes, including those on the
1370:"Neck Lumps and Bumps: Lymph nodes (glands) of the head"
760:
758:
756:
741:
637:
658:
299:- within the triangular boundary of the anterior belly
1125:"A Simplified Approach to the Lymph Nodes of the Neck"
818:
806:
678:
676:
753:
331:(Subdigastric nodes) - around the upper third of the
1123:
Mukherji, Suresh K.; Gujar; Londy, Frank J. (2002).
627:
625:
1432:
731:
729:
727:
700:
673:
1353:Medical Education Network: Screening Physical Exam
1349:"Clinical examination of the cervical lymph nodes"
1311:Archives of Otolaryngology–Head & Neck Surgery
1225:Archives of Otolaryngology–Head & Neck Surgery
1194:Archives of Otolaryngology–Head & Neck Surgery
1060:
694:
50:Regional lymph tissue (Cervical near top, in blue)
622:
2088:
905:"Neck Dissection and sentinel lymph node biopsy"
782:
770:
724:
712:
439:. The upper border is the hyoid, the lower the
1093:
800:
1418:
1346:
1221:
1189:
1153:Clinical and Experimental Otorhinolaryngology
1061:Eisenmenger, LB; Wiggins, RH (January 2015).
747:
652:
865:
667:
1286:Journal of the American Medical Association
1425:
1411:
1274:]. trans. Morris Jacob Tobias. Paris:
1146:
944:
824:
812:
56:
44:
1307:
1172:
1015:
972:
962:
885:
764:
1387:
1283:"Anatomie des lymphatiques de l'homme".
1260:
1122:
706:
682:
527:
361:Level IIb: Posterolateral to this plane.
118:
1367:
423:Level VI: Anterior compartment nodes -
411:, including the spinal accessory nodes.
2089:
1390:"Neck, Cervical Metastases, Detection"
1063:"Imaging of head and neck lymph nodes"
902:
631:
250:Memorial Sloan Kettering Cancer Center
1406:
989:
903:Buyten, Jeffrey (20 September 2006).
735:
1282:
1267:Anatomie des lymphatiques de l'homme
1207:10.1001/archotol.1991.01870180037007
1032:
840:
788:
776:
718:
585:
276:
140:Anterior Cervical Lymph Nodes (Deep)
1388:Gosselin, Benoit J (8 March 2016).
1067:Radiologic Clinics of North America
248:numbered groupings, devised at the
13:
1347:Chandrasekhar, A (28 March 2006).
873:American Journal of Neuroradiology
271:American Joint Committee on Cancer
254:American Academy of Otolaryngology
179:Inferior Deep Cervical Lymph Nodes
14:
2108:
1340:
849:Springer International Publishing
263:
223:
1299:10.1001/jama.1932.02740720070042
604:
592:
2097:Lymphatics of the head and neck
833:
496:Level VII: Suprasternal notch,
1881:Bronchomediastinal lymph trunk
1293:(20): 1716. 12 November 1932.
695:Eisenmenger & Wiggins 2015
443:, and the lateral borders the
1:
1368:Harding, Mary (5 July 2017).
616:
16:Lymph nodes found in the neck
1108:10.1016/j.radonc.2013.10.010
339:. The upper boundary is the
134:Submandibular (Submaxillary)
7:
1008:10.1102/1470-7330.2004.0020
611:The lymphatics of the face.
580:papillary thyroid carcinoma
10:
2113:
1324:10.1001/archotol.125.4.388
1238:10.1001/archotol.128.7.751
844:AJCC Cancer Staging Manual
394:transverse cervical artery
349:sternocleidomastoid muscle
231:
96:nodi lymphoidei cervicales
25:External iliac lymph nodes
18:
2044:
2014:
1907:
1900:
1893:
1863:
1805:
1798:
1778:
1720:
1713:
1693:
1663:
1591:
1568:
1559:
1510:
1455:
1448:
1441:
1096:Radiotherapy and Oncology
1079:10.1016/j.rcl.2014.09.011
964:10.1186/s13014-015-0490-9
437:recurrent laryngeal nerve
242:upper aerodigestive tract
188:Supraclavicular (scalene)
161:Deep Cervical Lymph Nodes
101:
89:
84:
72:
67:
55:
43:
36:
1165:10.3342/ceo.2015.8.3.289
533:Infectious mononucleosis
183:
990:Chong, Vincent (2004).
575:squamous cell carcinoma
445:common carotid arteries
165:
144:
1823:Superior diaphragmatic
1786:Subclavian lymph trunk
1638:inferior deep cervical
1633:superior deep cervical
1601:Deep anterior cervical
1468:Mastoid/retroauricular
599:Lymphatics of pharynx.
564:fine needle aspiration
562:. Tissue diagnosis by
312:Submandibular triangle
194:
103:Anatomical terminology
1628:Deep lateral cervical
528:Clinical significance
409:anterior cricoid arch
398:supraclavicular nodes
333:internal jugular vein
122:
1876:Right lymphatic duct
1042:(Seventh ed.).
368:Middle jugular nodes
318:and the body of the
198:Cervical lymph nodes
38:Cervical lymph nodes
29:Inguinal lymph nodes
1965:Inferior mesenteric
1949:Superior mesenteric
1828:Trachea and bronchi
1355:. Loyola University
1131:(2). Archived from
847:(Eighth ed.).
801:Gregoire et al 2013
558:techniques such as
514:prevertebral fascia
396:, and includes the
383:Lower jugular nodes
353:submandibular gland
329:Upper jugular nodes
291:submandibular nodes
2022:Lumbar lymph trunk
951:Radiation Oncology
748:Robbins et al 1991
653:Robbins et al 2002
441:suprasternal notch
376:sternohyoid muscle
195:
2084:
2083:
2040:
2039:
2010:
2009:
1889:
1888:
1794:
1793:
1709:
1708:
1689:
1688:
1671:Anterior cervical
1555:
1554:
1053:978-0-387-88442-4
925:on 27 August 2014
858:978-3-319-40617-6
668:Brekel et al 1998
586:Additional images
536:(glandular fever)
522:radiation therapy
498:Innominate artery
402:trapezius muscles
372:cricoid cartilage
345:stylohyoid muscle
341:base of the skull
316:stylohyoid muscle
301:digastric muscles
277:Lymph node levels
117:
116:
112:
2104:
2027:Intestinal trunk
1905:
1904:
1898:
1897:
1843:bronchopulmonary
1803:
1802:
1718:
1717:
1676:Lateral cervical
1566:
1565:
1453:
1452:
1446:
1445:
1435:lymphatic system
1427:
1420:
1413:
1404:
1403:
1399:
1384:
1382:
1380:
1374:Patient Platform
1364:
1362:
1360:
1335:
1302:
1279:
1257:
1218:
1186:
1176:
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1141:
1140:
1119:
1090:
1057:
1041:
1029:
1019:
986:
976:
966:
934:
932:
930:
924:
918:. Archived from
909:
899:
889:
862:
828:
822:
816:
810:
804:
798:
792:
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774:
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692:
686:
680:
671:
665:
656:
650:
635:
629:
608:
596:
418:which is in IV).
170:Anterior jugular
125:Deep Lymph Nodes
109:edit on Wikidata
106:
79:Lymphatic system
60:
48:
34:
33:
2112:
2111:
2107:
2106:
2105:
2103:
2102:
2101:
2087:
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2085:
2080:
2036:
2006:
2002:Retroperitoneal
1885:
1859:
1790:
1774:
1705:
1685:
1681:Supraclavicular
1659:
1653:jugulo-omohyoid
1648:jugulodigastric
1643:retropharyngeal
1587:
1551:
1506:
1493:infra-auricular
1437:
1433:Anatomy of the
1431:
1378:
1376:
1358:
1356:
1343:
1338:
1262:Rouvière, Henri
1138:
1136:
1054:
1039:
928:
926:
922:
907:
859:
836:
831:
825:Park et al 2015
823:
819:
813:Chen et al 2015
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659:
651:
638:
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623:
619:
612:
609:
600:
597:
588:
556:nuclear imaging
542:lymph nodes on
530:
478:cervical plexus
337:accessory nerve
279:
266:
258:neck dissection
234:
226:
191:
176:
173:Jugulodigastric
167:Lateral jugular
158:
137:
113:
63:
51:
32:
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2110:
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2099:
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2062:Cloquet's node
2048:
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2041:
2038:
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2034:
2032:Cisterna chyli
2029:
2024:
2018:
2016:
2012:
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2004:
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1853:intrapulmonary
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1763:Supratrochlear
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1714:Arm and axilla
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1498:intraglandular
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1341:External links
1339:
1337:
1336:
1318:(4): 388–396.
1305:
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1303:
1258:
1232:(7): 751–758.
1219:
1201:(6): 601–605.
1187:
1159:(3): 289–294.
1144:
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1102:(1): 172–181.
1091:
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1002:(2): 116–120.
996:Cancer Imaging
987:
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880:(4): 695–700.
863:
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416:Virchow's node
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264:Modern systems
262:
238:Henri Rouvière
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185:Juguloomohyoid
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1871:Thoracic duct
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1768:Deltopectoral
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1701:Jugular trunk
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1540:Submandibular
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1442:Head and neck
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1135:on 2021-02-27
1134:
1130:
1129:Neurographics
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1073:(1): 115–32.
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707:Rouvière 1932
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683:Mukherji 2002
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572:head and neck
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1848:paratracheal
1616:prelaryngeal
1611:paratracheal
1560:
1488:preauricular
1393:
1377:. Retrieved
1373:
1357:. Retrieved
1352:
1315:
1309:
1290:
1284:
1271:
1266:
1229:
1223:
1198:
1192:
1156:
1152:
1137:. Retrieved
1133:the original
1128:
1099:
1095:
1070:
1066:
1035:
999:
995:
954:
950:
927:. Retrieved
920:the original
912:Grand Rounds
911:
877:
871:
843:
834:Bibliography
820:
808:
796:
784:
772:
743:
714:
702:
690:
535:
531:
518:
458:
450:
429:paratracheal
280:
267:
246:
235:
227:
218:inflammation
197:
196:
155:Paratracheal
146:Prelaryngeal
95:
37:
2069:superficial
1912:Retroaortic
1818:Intercostal
1813:Parasternal
1743:Subscapular
1606:pretracheal
1570:Superficial
1478:Superficial
632:Buyten 2006
453:mediastinal
425:Pretracheal
366:Level III:
202:lymph nodes
152:Pretracheal
85:Identifiers
1970:pararectal
1953:mesenteric
1917:Paraaortic
1535:Mandibular
1528:nasolabial
1523:buccinator
1289:(Review).
1139:2018-07-13
1046:New York.
957:(1): 181.
736:Chong 2004
617:References
568:metastatic
552:ultrasound
433:precricoid
381:Level IV:
327:Level II:
310:Level Ib:
295:Level Ia:
2076:Popliteal
1959:mesocolic
1956:ileocolic
1922:Preaortic
1547:Submental
1463:Occipital
789:AJCC 2009
777:AJCC 2018
719:JAMA 1932
560:PET scans
540:cancerous
510:esophagus
297:Submental
287:Submental
285:Level I:
214:infection
131:Submental
2091:Category
2052:Inguinal
1990:internal
1985:external
1838:inferior
1833:superior
1738:Pectoral
1733:Brachial
1728:Axillary
1578:anterior
1561:Cervical
1398:. WebMD.
1395:Medscape
1332:10208676
1264:(1932).
1246:12117328
1183:26330926
1116:24183870
1087:25476176
1044:Springer
1026:18250018
983:26302761
387:clavicle
320:mandible
303:and the
2015:Vessels
1942:splenic
1937:hepatic
1932:gastric
1894:Abdomen
1864:Vessels
1779:Vessels
1748:Central
1694:Vessels
1621:thyroid
1583:lateral
1473:Parotid
1379:17 July
1359:17 July
1254:8708884
1215:2036180
1174:4553362
1017:1434593
974:4554293
929:13 July
896:9576657
887:8337385
544:CT scan
506:Trachea
502:Sternum
232:History
210:tumours
149:Thyroid
68:Details
1997:Sacral
1980:Common
1976:Iliac
1927:Celiac
1753:Apical
1518:Facial
1330:
1276:Masson
1252:
1244:
1213:
1181:
1171:
1114:
1085:
1050:
1024:
1014:
981:
971:
938:Slides
894:
884:
855:
512:, and
487:muscle
483:plexus
74:System
23:, see
21:cervix
1901:Nodes
1806:Nodes
1799:Chest
1721:Nodes
1664:Other
1511:Front
1270:[
1250:S2CID
1040:(PDF)
923:(PDF)
908:(PDF)
307:bone.
305:hyoid
107:[
91:Latin
2057:deep
1759:Arm
1593:Deep
1483:Deep
1456:Back
1449:Head
1381:2018
1361:2018
1328:PMID
1242:PMID
1211:PMID
1179:PMID
1112:PMID
1083:PMID
1048:ISBN
1022:PMID
979:PMID
931:2018
892:PMID
853:ISBN
289:and
216:and
206:neck
200:are
27:and
2045:Leg
1320:doi
1316:125
1295:doi
1234:doi
1230:128
1203:doi
1199:117
1169:PMC
1161:doi
1104:doi
1100:110
1075:doi
1012:PMC
1004:doi
969:PMC
959:doi
882:PMC
550:or
548:MRI
2093::
1392:.
1372:.
1351:.
1326:.
1314:.
1291:99
1248:.
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1081:.
1071:53
1069:.
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998:.
994:.
977:.
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955:10
953:.
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890:.
878:19
876:.
870:.
851:.
755:^
726:^
675:^
660:^
639:^
624:^
582:.
546:,
508:,
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431:,
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220:.
212:,
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1006::
1000:4
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767:.
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709:.
697:.
685:.
670:.
655:.
634:.
447:.
322:.
111:]
31:.
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
