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Surgical anatomy of the lymphatic drainage of the salivary glands: a systematic review

Published online by Cambridge University Press:  07 October 2020

A K Abou-Foul
A K Abou-Foul*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
*
Author for correspondence: Dr Ahmad K Abou-Foul, Department of Otolaryngology, Head and Neck Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, LondonW2 1NY, UK E-mail: Dr.akaboufoul@hotmail.com
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Abstract

Background

Nodal metastasis in salivary gland malignancies has important clinical implications; a good understanding of their complex anatomy is paramount to the head and neck surgeon.

Methods

A contemporary and comprehensive literature review was conducted of the lymphatic drainage of the salivary glands, with special emphasis on its surgical applications.

Results

The parotid gland has extraglandular and intraglandular nodes acting as a single functional drainage unit. Intraglandular parotid notes are unique to the parotid gland, and consist of a larger superficial group and a smaller deep group. The presence of intraglandular submandibular nodes, as described by early anatomists, is much debated nowadays. The sublingual glands drain to the lingual lymph nodes, which are divided into median, intermediate and lateral groups.

Conclusion

This review highlights the complex arrangements of lymph nodes draining the salivary glands. It may provide a valid anatomical explanation for the nodal metastasis patterns commonly seen in salivary gland malignancy.

Keywords

Salivary GlandsLymph NodesParotid GlandMalignancySubmandibular GlandSublingual Gland
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 10 , October 2020 , pp. 856 - 862
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

Dr A K Abou-Foul takes responsibility for the integrity of the content of the paper

References

Beale, T, Madani, G. Anatomy of the salivary glands. Semin Ultrasound CT MR 2006;27:436–9CrossRefGoogle ScholarPubMed
Bhattacharyya, N, Fried, MP. Nodal metastasis in major salivary gland cancer: predictive factors and effects on survival. Arch Otolaryngol Head Neck Surg 2002;128:904–8CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG;, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:b2535CrossRefGoogle ScholarPubMed
Rouvière, H. Anatomy of the Human Lymphatic System (translated by Tobias, MJ). Ann Arbor: Edwards Brothers, 1938;5–28Google Scholar
Marks, NJ. The anatomy of the lymph nodes of the parotid gland. Clin Otolaryngol Allied Sci 1984;9:271–5CrossRefGoogle ScholarPubMed
Carlson, GW. The salivary glands. Embryology, anatomy, and surgical applications. Surg Clin North Am 2000;80:261–73Google ScholarPubMed
McKean, ME, Lee, K, McGregor, IA. The distribution of lymph nodes in and around the parotid gland: an anatomical study. Br J Plast Surg 1985;38:1–5CrossRefGoogle ScholarPubMed
Sönmez Ergün, S, Gayretli, O, Büyükpınarbaşılı, N, Yıldız, K, Gürses, IA, Avşar, A et al. Determining the number of intraparotid lymph nodes: postmortem examination. J Craniomaxillofac Surg 2014;42:657–60CrossRefGoogle ScholarPubMed
Poirier, P, Cuneo, B, Delamere, G. The Lymphatics (translated by Leaf, CH). Westminster: Archibald Constable & Co, 1903;247–89Google Scholar
Pisani, P, Ramponi, A, Pia, F. The deep parotid lymph nodes: an anatomical and oncological study. J Laryngol Otol 1996;110:148–50CrossRefGoogle ScholarPubMed
Garatea-Crelgo, J, Gay-Escoda, C, Bermejo, B, Buenechea-Imaz, R. Morphological study of the parotid lymph nodes. J Craniomaxillofac Surg 1993;21:207–9CrossRefGoogle ScholarPubMed
Lengelé, B, Hamoir, M, Scalliet, P, Grégoire, V. Anatomical bases for the radiological delineation of lymph node areas. Major collecting trunks, head and neck. Radiother Oncol 2007;85:146–55CrossRefGoogle ScholarPubMed
DiNardo, LJ. Lymphatics of the submandibular space: an anatomic, clinical, and pathologic study with applications to floor-of-mouth carcinoma. Laryngoscope 1998;108:206–14CrossRefGoogle ScholarPubMed
Abe, M, Murakami, G, Noguchi, M, Yajima, T, Kohama, GI. Afferent and efferent lymph-collecting vessels of the submandibular nodes with special reference to the lymphatic route passing through the mylohyoid muscle. Head Neck 2003;25:59–66CrossRefGoogle ScholarPubMed
Ananian, SG, Gvetadze, SR, Ilkaev, KD, Mochalnikova, VV, Zayratiants, GO, Mkhitarov, VA et al. Anatomic-histologic study of the floor of the mouth: the lingual lymph nodes. Jpn J Clin Oncol 2015;45:547–54Google ScholarPubMed
Katayama, T. Anatomical study of the lymphatic system of the mouth [in Japanese]. J Nippon Dent Assoc 1943;30:647–77Google Scholar
Stong, BC, Johns, ME, Johns, MM. Anatomy and physiology of the salivary glands. In: Bailey, BJ, Johnson, JT, eds. Head and Neck Surgery - Otolaryngology, 4th edn. Philadelphia: Lippincott Williams & Wilkins, 2006;517–25Google Scholar
Som, PM. Lymph nodes of the neck. Radiology 1987;165:593–600CrossRefGoogle Scholar
Batsakis, JG. Pathology consultation. Parotid gland and its lymph nodes as metastatic sites. Ann Otol Rhinol Laryngol 1983;92(2 Pt 1):209–10CrossRefGoogle ScholarPubMed
Taylor, BW Jr, Brant, TA, Mendenhall, NP, Mendenhall, WM, Cassisi, NJ, Stringer, SP et al. Carcinoma of the skin metastatic to parotid area lymph nodes. Head Neck 1991;13:427–33CrossRefGoogle ScholarPubMed
Grégoire, V, Ang, K, Budach, W, Grau, C, Hamoir, M, Langendijk, JA et al. Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol 2014;110:172–81CrossRefGoogle ScholarPubMed
Graham, JW. Metastatic cancer in the parotid lymph nodes. Med J Aust 1965;2:8–12CrossRefGoogle ScholarPubMed
Cracchiolo, JR, Shaha, AR. Parotidectomy for parotid cancer. Otolaryngol Clin North Am 2016;49:415–24CrossRefGoogle ScholarPubMed
McKenzie, J. The parotid gland in relation to the facial nerve. J Anat 1948;82:183–6Google ScholarPubMed
Robbins, KT, Clayman, G, Levine, PA, Medina, J, Sessions, R, Shaha, A et al. ; American Head and Neck Society; American Academy of Otolaryngology--Head and Neck Surgery. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg 2002;128:751–8CrossRefGoogle ScholarPubMed
Robbins, KT, Shaha, AR, Medina, JE, Califano, JA, Wolf, GT, Ferlito, A et al. ; Committee for Neck Dissection Classification, American Head and Neck Society. Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg 2008;134:536–8CrossRefGoogle ScholarPubMed
Bartels, P. To understand how lung cancer can spread [in German]. Anat Anz 1907;31:330–44Google Scholar
Spiegel, JH, Brys, AK, Bhakti, A, Singer, MI. Metastasis to the submandibular gland in head and neck carcinomas. Head Neck 2004;26:1064–8CrossRefGoogle ScholarPubMed
Dhiwakar, M, Ronen, O, Malone, J, Rao, K, Bell, S, Phillips, R et al. Feasibility of submandibular gland preservation in neck dissection: a prospective anatomic-pathologic study. Head Neck 2011;33:603–9CrossRefGoogle ScholarPubMed
Fives, C, Feeley, L, Sadadcharam, M, O'Leary, G, Sheahan, P. Incidence of intraglandular lymph nodes within submandibular gland, and involvement by floor of mouth cancer. Eur Arch Otorhinolaryngol 2017;274:461–6CrossRefGoogle ScholarPubMed
Basaran, B, Ulusan, M, Orhan, KS, Gunes, S, Suoglu, Y. Is it necessary to remove submandibular glands in squamous cell carcinomas of the oral cavity? Acta Otorhinolaryngol Ital 2013;33:88–92Google ScholarPubMed
Lim, YC, Kim, JW, Koh, YW, Kim, K, Kim, HJ, Kim, KM et al. Perivascular-submandibular lymph node metastasis in squamous cell carcinoma of the tongue and floor of mouth. Eur J Surg Oncol 2004;30:692–8CrossRefGoogle ScholarPubMed
Küttner, H. About the lymph vessels and lymph glands of the tongue with relation to the spread of tongue carcinoma [in German]. Beitr Klin Chir 1898;21:732Google Scholar
Zhang, T, Ord, RA, Wei, WI, Zhao, J. Sublingual lymph node metastasis of early tongue cancer: report of two cases and review of the literature. Int J Oral Maxillofac Surg 2011;40:597–600CrossRefGoogle ScholarPubMed
Kaya, I, Öztürk, K, Turhal, G. Sublingual lymph node metastasis in early-stage floor of the mouth carcinoma. Turk Arch Otorhinolaryngol 2017;55:177–9CrossRefGoogle ScholarPubMed
Woolgar, JA. Histological distribution of cervical lymph nodes from intraoral/oropharyngeal squamous cell carcinomas. Br J Oral Maxillofac Surg 1999;37:175–80CrossRefGoogle ScholarPubMed
Hiatt, JL, Sauk, JJ. Embryology and anatomy of the salivary glands. In: Ellis, GL, Auclair, PL, Gnepp, DR, eds. Surgical Pathology of the Salivary Glands. Philadelphia: WB Saunders, 1991;2–10Google Scholar
Hay, AJ, Migliacci, J, Karassawa Zanoni, D, McGill, M, Patel, S, Ganly, I. Minor salivary gland tumors of the head and neck--Memorial Sloan Kettering experience: incidence and outcomes by site and histological type. Cancer 2019;125:3354–66CrossRefGoogle ScholarPubMed
Moreno, M, Moreno, A, Tomé, C. Sentinel lymph node biopsy in adenocarcinoma of minor salivary gland. Oral Oncol 2008;44:305–8CrossRefGoogle ScholarPubMed
Pan, WR, Le Roux, CM, Briggs, CA. Variations in the lymphatic drainage pattern of the head and neck: further anatomic studies and clinical implications. Plast Reconstr Surg 2011;127:611–20CrossRefGoogle ScholarPubMed
Ferlito, A, Shaha, AR, Rinaldo, A, Pellitteri, PK, Mondin, V, Byers, RM. “Skip metastases” from head and neck cancers. Acta Otolaryngol 2002;122:788–91CrossRefGoogle ScholarPubMed