Nasopharynx Cancer. With nodal dissemination, the high parapharyngeal nodes along the carotid sheath are involved and extend into the retrostyloid compartment.This leads to entrapment of the cranial nerves emerging alongside the jugular foramen. The nodes in this region are named after Rouviere–famous for his treatise on lymphoid anatomy. Again, numerous neurologic syndromes can occur. The retroparotidian syndrome, or the jugular foramen syndrome, is characterized by loss of the gag reflex (cranial nerve IX), vocal cord paralysis (cranial nerve X), atrophy of the trapezius muscle (cranial nerve XI), and deviation of the uvula (cranial nerve IX) and tongue on protrusion (cranial nerve XII).

In addition to retropharyngeal and parapharyngeal nodes, the main routes of lymphatic spread of the nasopharynx are into the first station nodes, that is, the jugulodigastric, jugulo-omohyoid, upper deep cervical, lower deep cervical, and submaxillary and submental lymph nodes. Bilateral node spread is common. Mediastinal lymph node metastases are considered distant metastases. Distant spread to the lungs is common in this type of cancer.