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Tirelli et al. J Cancer Metastasis Treat 2023;9:20 Journal of Cancer
DOI: 10.20517/2394-4722.2022.98
Metastasis and Treatment

Narrative Review Open Access

Lymph nodes of the perimandibular area: from
anatomical classification to pathological role in

cancer of the oral cavity, oropharynx and skin

Giancarlo Tirelli, Francesco Uderzo, Nicoletta Gardenal, Paolo Boscolo-Rizzo, Alberto Vito Marcuzzo
ENT & Head and Neck Clinic, Cattinara Hospital - ASUGI Strada di Fiume 447, Trieste 34100 Italy.

Correspondence to: Dr. Alberto Vito Marcuzzo, ENT & Head and Neck Clinic, Cattinara Hospital - ASUGI Strada di Fiume 447,
Trieste 34100, Italy. E-mail: avmarcuzzo@gmail.com

How to cite this article: Tirelli G, Uderzo F, Gardenal N, Boscolo-Rizzo P, Marcuzzo AV. Lymph nodes of the perimandibular area:
from anatomical classification to pathological role in cancer of the oral cavity, oropharynx and skin. J Cancer Metastasis Treat
2023;9:20. https://dx.doi.org/10.20517/2394-4722.2022.98
Received: 2 Aug 2022 First Decision: 6 Apr 2023 Revised: 13 Apr 2023 Accepted: 10 May 2023 Published: 23 May 2023

Academic Editors: Fausto Chiesa, Thomas Liehr Copy Editor: Fangling Lan Production Editor: Fangling Lan

Abstract
Lymph node status of the neck is the most important prognostic factor in head and neck cancer. Neck dissection,
which consists of the systematic excision of the neck nodes, represents the gold standard of surgical treatment in
clinically positive necks. In cases in which metastases to lymph nodes of the neck are not detectable, the decision
to perform an elective neck dissection depends on the stage and the site of the primary tumor. This narrative
review focuses on the anatomical description and oncological role of a group of lymph nodes of the neck that
historically has not been well defined. Over the years, several authors have described the groups of lymph nodes
that lie where the facial vein crosses the mandible, but to date, no unique definition or a clear view of their
oncological role has been proposed. Recently, the term “perimarginal nodes” was coined to refer to this group of
lymph nodes, and emphasis was placed on the risk of leaving them undissected during neck dissection. This paper
aims to provide a surgical-anatomical classification of these lymph nodes and describe their oncological role on the
basis of a review of the relevant literature.
Keywords: Perimarginal nodes, perifacial nodes, submandibular nodes, Hayes Martin maneuver, facial vein, neck
dissection, level IB, submandibular triangle

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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