69:
57:
617:
605:
588:
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
258:
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
497:
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
530:
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
131:
486:
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
1201:
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".
255:, 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.
466:
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.
493:
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
279:
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
1105:
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".
1319:
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".
483:
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
1233:
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".
501:
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
415:, 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.
1321:
1235:
1435:
948:
480:
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
462:
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
915:
219:. 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
1296:
1588:
1045:
2107:
1593:
1508:
1503:
474:
Level IA: Symphysis of mandible, Body of hyoid, Anterior belly of contralateral digastric muscle, Anterior belly of ipsilateral digastric muscle
1428:
926:
260:
1498:
1062:
867:
251:
in his 1932 publication "Anatomie des
Lymphatiques de l'Homme" Rouviere described the cervical lymph nodes as a collar which surrounded the
1833:
1648:
1643:
1611:
883:
281:
264:
1638:
1421:
1400:
859:
1054:
400:, anteromedially by the lateral border of the sternohyoid and posterolaterally by the posterior border of the sternocleidomastoid.
2079:
1753:
1580:
1158:
Park, Chang Ho; Song, Chang Myeon; Ji, Yong Bae; Pyo, Ju Yeon; Yi, Ki Jong; Song, Young Soo; Park, Yong Wook; Tae, Kyung (2015).
1975:
1959:
1488:
1891:
381:- around the middle third of the internal jugular vein, from the inferior border of the hyoid to the inferior border of the
1748:
1681:
1853:
1848:
1843:
1838:
1686:
284:(AJCC). The AJCC system from the 7th edition of the Staging Manual (2009) remains unchanged in the 8th edition of 2018.
1135:
2012:
1691:
1653:
930:
590:
477:
Level IB: Body of mandible, Posterior belly of digastric muscle, Anterior belly of digastric muscle, Stylohyoid muscle
408:
2000:
1995:
1773:
1663:
1658:
1204:
404:
359:
35:
425:
Level VB: Lymph nodes below this plane, including the transverse cervical nodes and supraclavicular nodes (except
2067:
1778:
1603:
1550:
447:
879:"The size of lymph nodes in the neck on sonograms as a radiologic criterion for metastasis: how reliable is it?"
1990:
1858:
1626:
1621:
1493:
1073:
543:
439:
239:
There are approximately 300 lymph nodes in the neck, and they can be classified in a number of different ways.
1922:
1828:
1823:
1616:
585:
455:
435:
2037:
1980:
1927:
1796:
1359:
574:
322:
113:
2086:
1557:
1545:
1538:
1533:
1473:
577:(which has a high rate of accuracy), may also be required. Involvement of the cervical lymph nodes with
419:
343:
307:
297:
616:
73:
Cervical lymph node levels (American
Academy of Otolaryngology system from 2002), and superficial nodes
2062:
1932:
1886:
1863:
1743:
1738:
582:
396:- around the lower third of the internal jugular vein from the inferior border of the cricoid to the
378:
354:
and the lower boundary is the inferior border of the hyoid bone. The anterior/medial boundary is the
39:
1952:
1947:
1942:
1758:
1711:
1631:
1483:
1478:
1160:"Significance of the Extracapsular Spread of Metastatic Lymph Nodes in Papillary Thyroid Carcinoma"
524:
443:
393:
363:
339:
252:
68:
604:
2032:
2007:
1937:
1763:
1528:
1286:
1260:
562:
451:
386:
362:. On imaging the anterior/medial boundary is the vertical plane of the posterior surface of the
301:
535:
also requires such an approach and has resulted in an international consensus guideline (2013).
403:
Level V: Posterior triangle nodes - around the lower half of the spinal accessory nerve and the
2072:
1338:
1252:
1221:
1189:
1122:
1093:
1058:
1032:
989:
902:
863:
532:
508:
426:
382:
355:
351:
326:
311:
248:
1445:
1330:
1305:
1244:
1213:
1179:
1171:
1114:
1085:
1022:
1014:
979:
969:
892:
412:
89:
1380:
566:
488:
411:. The upper boundary is the apex formed by the convergence of the sternocleidomastoid and
347:
268:
1217:
2042:
1272:
1184:
1159:
1027:
1002:
984:
957:
897:
878:
504:
Level VI: Hyoid bone, Suprasternal notch, Common carotid artery, Common carotid artery
2101:
1881:
1309:
1264:
470:
The boundaries are defined as (Superior, Inferior, Antero-medial, Postero-lateral)
292:
The
American Academy of Otolaryngology system (2002) divides the nodes as follows:
228:
84:
17:
1413:
271:
that was updated in 2002, including the addition of sub-levels, e.g. IIA and IIB.
130:
56:
1276:
1118:
927:
Department of Otolaryngology, The University of Texas Medical Branch at Galveston
853:
1018:
463:
1334:
1248:
589:
distant metastases. Cervical lymph node metastasis is also a common feature of
549:
affects the cervical lymph nodes which become swollen. The characterization of
1089:
974:
578:
212:
1175:
1283:
Anatomy of the Human Lymphatic System, Edwards Brothers, Ann Arbor, MI. 1938
1143:
520:
224:
1342:
1256:
1193:
1126:
1097:
1036:
993:
325:- within the boundaries of the anterior belly of the digastric muscle, the
1225:
958:"Lymph node ratio as a prognostic factor in head and neck cancer patients"
906:
418:
Level VA: Above the horizontal plane formed by the inferior border of the
247:
The classification of the cervical lymph nodes is generally attributed to
1405:
570:
397:
389:
and postero-laterally by the posterior border of the sternocleidomastoid.
330:
267:
published a standardised version of thisto provide a uniform approach to
220:
852:
Amin, Mahul B.; Edge, Stephen B.; Greene, Frederick L. (30 March 2018).
30:
This article is about lymph nodes in the neck. For lymph nodes near the
554:
516:
512:
119:
550:
369:
Level IIa: Anteromedial to the vertical plane of the accessory nerve.
31:
1044:
Edge, Stephen; Byrd, David R.; Compton, Carolyn C. (28 April 2011).
956:
Chen, Chien-Chih; Lin, Jin-Ching; Chen, Kuan-Wen (25 August 2015).
263:
in the 1930s. This has been variously modified since. In 1991, the
315:
129:
101:
1047:
AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual
385:. Antero-medially they are bounded by the lateral border of the
216:
1417:
558:
358:
and the posterior/lateral one is the posterior border of the
877:
van den Brekel, MW; Castelijns, JA; Snow, GB (April 1998).
659:
657:
655:
653:
651:
1003:"Cervical lymphadenopathy: what radiologists need to know"
674:
672:
581:
cancer is the single most important prognostic factor in
565:
is difficult, and usually requires confirmation by other
446:(Delphian) and perithyroid nodes, including those on the
1381:"Neck Lumps and Bumps: Lymph nodes (glands) of the head"
771:
769:
767:
310:- within the triangular boundary of the anterior belly
1136:"A Simplified Approach to the Lymph Nodes of the Neck"
689:
687:
342:(Subdigastric nodes) - around the upper third of the
1134:
Mukherji, Suresh K.; Gujar; Londy, Frank J. (2002).
638:
636:
2055:
2025:
1911:
1904:
1874:
1816:
1809:
1789:
1731:
1724:
1704:
1674:
1602:
1579:
1570:
1521:
1466:
1459:
1452:
742:
740:
738:
100:
95:
83:
78:
47:
1364:Medical Education Network: Screening Physical Exam
1360:"Clinical examination of the cervical lymph nodes"
1322:Archives of Otolaryngology–Head & Neck Surgery
1236:Archives of Otolaryngology–Head & Neck Surgery
1205:Archives of Otolaryngology–Head & Neck Surgery
705:
61:Regional lymph tissue (Cervical near top, in blue)
916:"Neck Dissection and sentinel lymph node biopsy"
450:. The upper border is the hyoid, the lower the
811:
1429:
1164:Clinical and Experimental Otorhinolaryngology
1072:Eisenmenger, LB; Wiggins, RH (January 2015).
758:
663:
8:
678:
1297:Journal of the American Medical Association
1915:
1908:
1813:
1728:
1576:
1463:
1456:
1436:
1422:
1414:
1285:]. trans. Morris Jacob Tobias. Paris:
835:
823:
67:
55:
1183:
1026:
983:
973:
896:
775:
1294:"Anatomie des lymphatiques de l'homme".
717:
693:
372:Level IIb: Posterolateral to this plane.
632:
600:
434:Level VI: Anterior compartment nodes -
422:, including the spinal accessory nodes.
1401:"Neck, Cervical Metastases, Detection"
1074:"Imaging of head and neck lymph nodes"
642:
261:Memorial Sloan Kettering Cancer Center
117:
44:
914:Buyten, Jeffrey (20 September 2006).
746:
7:
1278:Anatomie des lymphatiques de l'homme
1218:10.1001/archotol.1991.01870180037007
799:
787:
729:
151:Anterior Cervical Lymph Nodes (Deep)
1399:Gosselin, Benoit J (8 March 2016).
1078:Radiologic Clinics of North America
259:numbered groupings, devised at the
1358:Chandrasekhar, A (28 March 2006).
884:American Journal of Neuroradiology
282:American Joint Committee on Cancer
265:American Academy of Otolaryngology
190:Inferior Deep Cervical Lymph Nodes
25:
860:Springer International Publishing
1310:10.1001/jama.1932.02740720070042
615:
603:
2108:Lymphatics of the head and neck
507:Level VII: Suprasternal notch,
1892:Bronchomediastinal lymph trunk
1304:(20): 1716. 12 November 1932.
706:Eisenmenger & Wiggins 2015
454:, and the lateral borders the
1:
1379:Harding, Mary (5 July 2017).
27:Lymph nodes found in the neck
1119:10.1016/j.radonc.2013.10.010
350:. The upper boundary is the
145:Submandibular (Submaxillary)
1019:10.1102/1470-7330.2004.0020
622:The lymphatics of the face.
591:papillary thyroid carcinoma
2124:
1335:10.1001/archotol.125.4.388
1249:10.1001/archotol.128.7.751
855:AJCC Cancer Staging Manual
405:transverse cervical artery
360:sternocleidomastoid muscle
107:nodi lymphoidei cervicales
36:External iliac lymph nodes
29:
1918:
1107:Radiotherapy and Oncology
1090:10.1016/j.rcl.2014.09.011
975:10.1186/s13014-015-0490-9
448:recurrent laryngeal nerve
253:upper aerodigestive tract
199:Supraclavicular (scalene)
172:Deep Cervical Lymph Nodes
112:
66:
54:
1176:10.3342/ceo.2015.8.3.289
544:Infectious mononucleosis
194:
1001:Chong, Vincent (2004).
586:squamous cell carcinoma
456:common carotid arteries
176:
155:
1834:Superior diaphragmatic
1797:Subclavian lymph trunk
1649:inferior deep cervical
1644:superior deep cervical
1612:Deep anterior cervical
1479:Mastoid/retroauricular
610:Lymphatics of pharynx.
575:fine needle aspiration
573:. Tissue diagnosis by
323:Submandibular triangle
205:
114:Anatomical terminology
1639:Deep lateral cervical
539:Clinical significance
420:anterior cricoid arch
409:supraclavicular nodes
344:internal jugular vein
133:
1887:Right lymphatic duct
1053:(Seventh ed.).
379:Middle jugular nodes
329:and the body of the
209:Cervical lymph nodes
49:Cervical lymph nodes
40:Inguinal lymph nodes
1976:Inferior mesenteric
1960:Superior mesenteric
1839:Trachea and bronchi
1366:. Loyola University
1142:(2). Archived from
858:(Eighth ed.).
812:Gregoire et al 2013
569:techniques such as
525:prevertebral fascia
407:, and includes the
394:Lower jugular nodes
364:submandibular gland
340:Upper jugular nodes
302:submandibular nodes
18:Cervical lymph node
2033:Lumbar lymph trunk
962:Radiation Oncology
759:Robbins et al 1991
664:Robbins et al 2002
452:suprasternal notch
387:sternohyoid muscle
206:
2095:
2094:
2051:
2050:
2021:
2020:
1900:
1899:
1805:
1804:
1720:
1719:
1700:
1699:
1682:Anterior cervical
1566:
1565:
1064:978-0-387-88442-4
936:on 27 August 2014
869:978-3-319-40617-6
679:Brekel et al 1998
597:Additional images
547:(glandular fever)
533:radiation therapy
509:Innominate artery
413:trapezius muscles
383:cricoid cartilage
356:stylohyoid muscle
352:base of the skull
327:stylohyoid muscle
312:digastric muscles
288:Lymph node levels
128:
127:
123:
16:(Redirected from
2115:
2038:Intestinal trunk
1916:
1909:
1854:bronchopulmonary
1814:
1729:
1687:Lateral cervical
1577:
1464:
1457:
1446:lymphatic system
1438:
1431:
1424:
1415:
1410:
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1393:
1391:
1385:Patient Platform
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1101:
1068:
1052:
1040:
1030:
997:
987:
977:
945:
943:
941:
935:
929:. Archived from
920:
910:
900:
873:
839:
833:
827:
821:
815:
809:
803:
797:
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785:
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691:
682:
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640:
619:
607:
429:which is in IV).
181:Anterior jugular
136:Deep Lymph Nodes
120:edit on Wikidata
90:Lymphatic system
71:
59:
45:
21:
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2017:
2013:Retroperitoneal
1896:
1870:
1801:
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1716:
1696:
1692:Supraclavicular
1670:
1664:jugulo-omohyoid
1659:jugulodigastric
1654:retropharyngeal
1598:
1562:
1517:
1504:infra-auricular
1448:
1444:Anatomy of the
1442:
1398:
1389:
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1378:
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1273:Rouvière, Henri
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836:Park et al 2015
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824:Chen et al 2015
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567:nuclear imaging
553:lymph nodes on
541:
489:cervical plexus
348:accessory nerve
290:
277:
269:neck dissection
245:
237:
202:
187:
184:Jugulodigastric
178:Lateral jugular
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2073:Cloquet's node
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2043:Cisterna chyli
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1774:Supratrochlear
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1509:intraglandular
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1352:External links
1350:
1348:
1347:
1329:(4): 388–396.
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1243:(7): 751–758.
1230:
1212:(6): 601–605.
1198:
1170:(3): 289–294.
1155:
1131:
1113:(1): 172–181.
1102:
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1013:(2): 116–120.
1007:Cancer Imaging
998:
953:
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911:
891:(4): 695–700.
874:
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427:Virchow's node
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275:Modern systems
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249:Henri Rouvière
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235:Classification
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196:Juguloomohyoid
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1882:Thoracic duct
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1712:Jugular trunk
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1551:Submandibular
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1453:Head and neck
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1146:on 2021-02-27
1145:
1141:
1140:Neurographics
1137:
1132:
1128:
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1084:(1): 115–32.
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718:Rouvière 1932
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694:Mukherji 2002
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583:head and neck
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1859:paratracheal
1627:prelaryngeal
1622:paratracheal
1571:
1499:preauricular
1404:
1388:. Retrieved
1384:
1368:. Retrieved
1363:
1326:
1320:
1301:
1295:
1282:
1277:
1240:
1234:
1209:
1203:
1167:
1163:
1148:. Retrieved
1144:the original
1139:
1110:
1106:
1081:
1077:
1046:
1010:
1006:
965:
961:
938:. Retrieved
931:the original
923:Grand Rounds
922:
888:
882:
854:
845:Bibliography
831:
819:
807:
795:
783:
754:
725:
713:
701:
546:
542:
529:
469:
461:
440:paratracheal
291:
278:
257:
246:
238:
229:inflammation
208:
207:
166:Paratracheal
157:Prelaryngeal
106:
48:
2080:superficial
1923:Retroaortic
1829:Intercostal
1824:Parasternal
1754:Subscapular
1617:pretracheal
1581:Superficial
1489:Superficial
643:Buyten 2006
464:mediastinal
436:Pretracheal
377:Level III:
213:lymph nodes
163:Pretracheal
96:Identifiers
1981:pararectal
1964:mesenteric
1928:Paraaortic
1546:Mandibular
1539:nasolabial
1534:buccinator
1300:(Review).
1150:2018-07-13
1057:New York.
968:(1): 181.
747:Chong 2004
628:References
579:metastatic
563:ultrasound
444:precricoid
392:Level IV:
338:Level II:
321:Level Ib:
306:Level Ia:
2087:Popliteal
1970:mesocolic
1967:ileocolic
1933:Preaortic
1558:Submental
1474:Occipital
800:AJCC 2009
788:AJCC 2018
730:JAMA 1932
571:PET scans
551:cancerous
521:esophagus
308:Submental
298:Submental
296:Level I:
225:infection
142:Submental
2102:Category
2063:Inguinal
2001:internal
1996:external
1849:inferior
1844:superior
1749:Pectoral
1744:Brachial
1739:Axillary
1589:anterior
1572:Cervical
1409:. WebMD.
1406:Medscape
1343:10208676
1275:(1932).
1257:12117328
1194:26330926
1127:24183870
1098:25476176
1055:Springer
1037:18250018
994:26302761
398:clavicle
331:mandible
314:and the
2026:Vessels
1953:splenic
1948:hepatic
1943:gastric
1905:Abdomen
1875:Vessels
1790:Vessels
1759:Central
1705:Vessels
1632:thyroid
1594:lateral
1484:Parotid
1390:17 July
1370:17 July
1265:8708884
1226:2036180
1185:4553362
1028:1434593
985:4554293
940:13 July
907:9576657
898:8337385
555:CT scan
517:Trachea
513:Sternum
243:History
221:tumours
160:Thyroid
79:Details
2008:Sacral
1991:Common
1987:Iliac
1938:Celiac
1764:Apical
1529:Facial
1341:
1287:Masson
1263:
1255:
1224:
1192:
1182:
1125:
1096:
1061:
1035:
1025:
992:
982:
949:Slides
905:
895:
866:
523:, and
498:muscle
494:plexus
85:System
34:, see
32:cervix
1912:Nodes
1817:Nodes
1810:Chest
1732:Nodes
1675:Other
1522:Front
1281:[
1261:S2CID
1051:(PDF)
934:(PDF)
919:(PDF)
318:bone.
316:hyoid
118:[
102:Latin
2068:deep
1770:Arm
1604:Deep
1494:Deep
1467:Back
1460:Head
1392:2018
1372:2018
1339:PMID
1253:PMID
1222:PMID
1190:PMID
1123:PMID
1094:PMID
1059:ISBN
1033:PMID
990:PMID
942:2018
903:PMID
864:ISBN
300:and
227:and
217:neck
211:are
38:and
2056:Leg
1331:doi
1327:125
1306:doi
1245:doi
1241:128
1214:doi
1210:117
1180:PMC
1172:doi
1115:doi
1111:110
1086:doi
1023:PMC
1015:doi
980:PMC
970:doi
893:PMC
561:or
559:MRI
2104::
1403:.
1383:.
1362:.
1337:.
1325:.
1302:99
1259:.
1251:.
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1208:.
1188:.
1178:.
1166:.
1162:.
1138:.
1121:.
1109:.
1092:.
1082:53
1080:.
1076:.
1031:.
1021:.
1009:.
1005:.
988:.
978:.
966:10
964:.
960:.
925:.
921:.
901:.
889:19
887:.
881:.
862:.
766:^
737:^
686:^
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635:^
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515:,
511:,
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231:.
223:,
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1017::
1011:4
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802:.
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778:.
761:.
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720:.
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696:.
681:.
666:.
645:.
458:.
333:.
122:]
42:.
20:)
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
