Quantification of level I neck lymph nodes for lymph node transfer in lymphedema treatment: an anatomical study and review of literature

Background: Vascularized lymph node transfer (VLNT) is an effective microsurgical method for the treatment of lymphedema. Knowledge of lymph node quantity and regional anatomy of donor sites are essential for surgery optimization. The aim of the study was to quantify the level I lymph nodes of the neck (submental and submandibular lymph nodes), describe the regional anatomy and review the current literature. Methods: Level I lymph nodes were identified from pathology specimens of 73 patients in Melbourne, Australia who underwent radical, modified, and selective neck dissection were quantified. Level I was further subcategorized into levels IA (submental) and IB (submandibular), with data assessed qualitatively and quantitatively. PubMed, Google Scholar, Science Direct, Cochrane CENTRAL, and trial registries (http:// clinicialtrials.gov/) were searched for relevant studies published from infinity to December 2021. Results: A mean of 5.2 & PLUSMN;2.9 lymph nodes were identified in the level I neck region. Subcategorization into level IA and level IB showed means of 3.7 & PLUSMN;1.6 and 4.7 & PLUSMN;3.0 lymph nodes, respectively. No statistical differences were detected regarding patients' gender (P=0.8) and age (P=0.5). Current literature shows level I neck VLNT is a suitable treatment for lymphedema. Conclusions: Level I of the neck offers a consistent quantity of lymph nodes and is suitable for free lymph node transfer. Current literature states VLNT is an effective technique for lymphedema treatment. This study details the regional anatomy of the level I neck lymph nodes, which will assist surgeons to optimize their surgeries and prevent donor-site morbidity.