British Journal of Oral and Maxillofucial Sur~erv C1997) 35.

142-143 I I

TECHNICAL NOTE

Needle localisation of the bucco-facial lymph node at surgery

A. M. Fordyce
Oral and Facial Unit, Sunderland District General Hospital, Sunderland

SUMMARY. A simple method of localising the hucco-facial lymph node at surgery is described, which facilitates
its excision biopsy.

INTRODUCTION material, so that by pulling on it, the node is tented

up towards the mucosal surface.
The bucco-facial lymph node is a mobile structure An intra-oral incision is made in the buccal mucosa
lying within the soft tissues of the cheek between skin close to the exit point of the needle, the node is
and buccinator muscle at the anterior border of approached by blunt dissection as the assistant tenses
masseter and is closely related to the mandibular the suture material to fix the node in the tissues
branch of the facial nerve and facial vessels. These (Fig. 3). The monofilament suture material can be
nodes, which are easily felt or seen by patients because
of their position overlying the ramus of the mandible,
can become persistently enlarged, often as one of a
number of enlarged reactive cervical nodes but
occasionally it may be the only palpable lymph node,
with no clear cause. If fine needle aspiration cytologi-
cal examination is unhelpful, excision biopsy may be
indicated to obtain a diagnosis.
Although easily palpable preoperatively, particu-
larly if the patient is asked to clench their teeth to
contract the masseter, it can be remarkably difficult
to localise in an anaesthetised patient. After the initial
incision has been made, the node is mobile, merges
with subcutaneous fat and can be even more difficult
to locate.
A simple method of peroperative localisation with
a needle and suture material is described which Fig. 1 - Position of node marked on the skin preoperatively.
facilitates node excision.

TECHNIQUE

The node is palpated and marked on the skin prior

to the local or general anaesthetic being administered
(Fig. 1). Once the patient is anaesthetised, prepared
and draped for operation, the node is palpated and
fixed digitally. A monofilament suture on a straight
needle is passed through the cheek via the skin,
transfixing the node, to emerge through oral mucosa
in the mouth (Fig. 2). At this stage one can check
that the node is indeed transfixed by attempting to
displace it within the cheek, whilst holding the needle
immobile.
Fig. 2 - Suture shown passing through the skin and node, emerging
The needle is pulled through the oral mucosa into into the oral cavity. In this case there was some doubt whether the
the mouth and a clamp placed on the needle tip; a first needle passed through the node and so a second suture was
bead or a clamp is retained at the end of the suture inserted.

142
 Needle localisation of the bucco-facial lymph node at surgery 143

followed within the substance of the cheek until the

node is encountered, and dissected free into the oral
cavity, still transfixed by the suture (Fig. 4). The
suture is cut adjacent to the skin and removed along
with the biopsy specimen. The mucosal incision is
closed using resorbable suture material.
This simple technique can save many minutes of
what may be frustrating and traumatic dissection,
with minimal morbidity to the patient.

Acknowledgement
I am grateful to Mr I. C. Martin, Consultant Oral and Facial
Surgeon, for his encouragement to produce this paper and for
permission to report procedures performed on his patients.
Fig. 3 - Suture tensed to bring the node towards the mucosal
surface.
The Author
A. M. Fordyce FRCS FDSRCS
Senior Registrar,
Oral and Facial Unit Sunderland District General Hospital
Kay11 Road
Sunderland SR4 7TP

Correspondence and requests for offprints to A. M. Fordyce,

Senior Registrar in Oral & Maxillofacial Surgery; Middlesbrough
General Hospital, Ayresome Green Lane, Middlesbrough,
Cleveland TS5 5AZ

Paper received 1 February 1995

Accepted 26 September 1995

Fig. 4 -Node seen dissected out, within the mouth, still transfixed
by the suture.