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The journal «ONCOSURGERY» 2013, Vol.5, No 2

Specifics of lymph drainage from mucosa of alveolar process and maxillary tuber, pterygomandibular fold, retromolar region, posterior areas of buccal mucosa

Chebotarev S.Ya.1,2, Gorban V.V.1,2, Petrishin V.L.1, Belov I.Yu.1

1) IP Pavlov Saint-Petersburg State Medical University,
2) AL Polenov Russian Research Neurosurgical Institute,
Saint-Petersburg, Russia
Contact: Gorban Vitaly Valerievich, e-mail:

There few publications about lymphatic system of oral cavity and its implication for tumor cell dissemination. Spread of squamous cell oral cancer through lymphatic and blood vessels of mandibular periostium and perineural lymphatics of mandibular canal is reviewed. The role of paravasal lymphatic vessels, accompanying lingual artery, in tumor spread to regional neck lymph nodes is assessed. We observe large number of patients with cancer in posterior parts of oral cavity accompanied by marked contracture without apparent changes in masticatory muscles or temporomandibular joints. There are also patients with progression of disease even after curable combined modality treatment for cancer of this localization. In this group of patients symptoms related to recurrence of disease in spaces surrounding ramus of mandible (contracture due to tumor infiltration) and in deep retromaxillar regions (symptoms of pterygopalatine fossa and infratemporal fossa) are observed.

In 5 patients the coloration of fat in pterygopalatine fossa and infratemporal fossa, upper pterygomaxillar space after dye injection was observed. We consider this to be due to several factors: 1) lymphatic vessels of lamina propria and submucosal of oral cavity confluent into collecting vessels which go to maxillary tuber where they drain to veins of pterygoid venous plexus; 2) periosteum of alveolar process of maxillary with its perforating venous and lymphatic vessels extends to maxillary tuber and thereafter on pterygoid processes (in the region of pterygomaxillar raphe). According to this we may determine alveolar process of maxillary (at least its posterior portion) and retromaxillar region as single functional system of lymph and blood circulation. The dye goes from alveolar portion of mandible mainly to mandibular lymph nodes and to submasseteric space. The transaction of masseter tendon showed that the dye goes to submasseteric space and through mandibular incisure to upper parts of pterygomaxillar space.

Injection net of buccal fat pad was observed in all cases.

The obtained results are crucial in understanding spreading of tumor and septic emboli from pathological sites in mucosa of posterior parts of oral cavity.

KEY WORDS: cancer of oral mucosa; metastasis; lymphatic system.


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  2. Maula S-M, Luukkaa M, Grénman R, et al. Head and neck region spread and prognosis in squamous cell carcinomas of the intratumoral lymphatics are essential for the metastatic. Cancer Res. 2003; 63: 1920−26.
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  4. Wei-Ren Pan, Suami H, Taylor GI. Lymphatic drainage of the superficial tissues of the head and neck: anatomical study and clinical implications. Plastic Reconstructive Surgery. May. 2008.

P. 67-71

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