Management of the Central Compartment in Well-Differentiated Thyroid Carcinoma
The central compartment of the neck is bounded superiorly by the hyoid bone, laterally by the carotid arteries, anteriorly by the superficial layer of the deep cervical fascia, posteriorly by the deep layer of the deep cervical fascia, and inferiorly by the innominate artery on the right and the corresponding axial plane on the left.  As illustrated in Fig. 3.1, the first echelon of lymphatic drainage of the thyroid is to the pretracheal, paratracheal and recurrent laryngeal nodes in the central compartment (level VI). This puts them at the highest risk of lymphatic metastasis in thyroid cancer. Subsequent lymphatic spread takes place to the superior mediastinal lymph nodes (level VII) and/or the lateral compartment of the neck (levels II–V), as has been outlined in Chap. 2 on lymph node metastasis in well-differentiated thyroid carcinoma (WDTC). Microscopic involvement of regional node occurs in 30–90 % of cases of papillary thyroid carcinomas (PTCs), with an incidence of clinically evident lymph node metastases at presentation ranging from 30 to 40 % [2–5]. The most commonly involved central lymph nodes in thyroid carcinoma are the prelaryngeal (Delphian), pretracheal, and the right and left paratracheal nodes .
KeywordsNeck Dissection Recurrent Laryngeal Nerve Total Thyroidectomy Central Compartment Central Neck
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