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Lymph node levels of the neck

Lymph nodes in the neck have been divided into seven levels, generally for the purpose of squamous cell carcinoma staging. This system is not inclusive of several important groups, however, such as the supraclavicular, parotid and retropharyngeal space nodes. 

Level I  
  • below mylohyoid muscle and above the lower margin of the hyoid bone 
  • anterior to the posterior border of the submandibular glands
    • level Ia: submental nodes, i.e. between the anterior bellies of the digastric muscles
    • level Ib: submandibular nodes, i.e. posterolateral to the anterior belly of the digastric muscles
Level II
  • internal jugular (deep cervical) chain
  • base of the skull to the inferior border of hyoid bone
  • anterior to the posterior border of sternocleidomastoid (SCM) muscle
  • posterior to the posterior border of the submandibular glands
    • level IIa: anterior, lateral, or medial to the vein or posterior to the internal jugular vein and inseparable from it
    • level IIb: posterior to the internal jugular vein and have a fat plane separating the nodes and the vein 
Level III
Level IV
  • internal jugular (deep cervical) chain
  • lower margin of cricoid cartilage to level of the clavicle
  • anterior and medial to an oblique line drawn through the posterior edge of the sternocleidomastoid muscle and the posterolateral edge of the anterior scalene muscle 4
  • lateral to the medial margin of the CCA
Level V
  • posterior triangle (spinal accessory) nodes
    • level Va: superior half, posterior to levels II and III (between base of the skull and inferior border of cricoid cartilage)
    • level Vb: inferior half, posterior to level IV (between the inferior border of cricoid cartilage and the level of clavicles)
Level VI
  • prelaryngeal/pretracheal/Delphian node
  • anterior to visceral space
  • from the inferior margin of hyoid bone to the manubrium
  • anterior to of levels III and IV
Level VII 
  • superior mediastinal nodes
  • between CCAs, below superior aspect of manubrium

See also


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