Lymph node levels of the neck

A.Prof Frank Gaillard et al.

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, retropharyngeal space, and occipital nodes. 

Level I  
  • below mylohyoid muscle and above the lower margin of the hyoid bone (or the carotid bifurcation)
  • 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 and anterior to the posterior border of the submandibular glands
Level II
  • internal jugular (deep cervical) chain
  • base of the skull to the inferior border of hyoid bone (or the carotid bifurcation)
  • anterior to the posterior border of sternocleidomastoid (SCM) muscle
  • posterior to the posterior border of the submandibular glands
    • level IIa: anterior, lateral, medial, or posterior to the internal jugular vein. If the node is posterior to the internal jugular vein, it must be inseparable from it
      • most superior node is the jugulodigastric node
    • 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 SCM 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
  • posterior to the back of the sternocleidomastoid muscle and anterior to the trapezius muscle 
    • 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
Level VII 
  • superior mediastinal nodes
  • between CCAs, below superior aspect of manubrium to level of the brachiocephalic vein

See also

Head and neck anatomy
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Article information

rID: 1615
System: Head & Neck
Synonyms or Alternate Spellings:
  • Cervical lymph node stations
  • Cervical lymph node levels
  • Neck nodal stations
  • Neck nodal levels

Cases and figures

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    Lymph Node Levels...
    Figure 1: lymph node levels
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  • Drag
    R Vb Necrotic Nod...
    Case 1: level Va node
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    Case 2: level VI (Delphian) node
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