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 and retropharyngeal space 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
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, 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
- internal jugular (deep cervical) chain
- lower margin of hyoid to lower margin of cricoid cartilage (or the intermediate tendon of Omohyoid)
- anterior to the posterior border of SCM
- lateral to the medial margin of the common carotid artery (CCA) / internal carotid artery (ICA)
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
- 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 levels III and IV
Level VII
- superior mediastinal nodes
- between CCAs, below superior aspect of manubrium to level of the brachiocephalic vein
See also
Related articles
Head and neck anatomy
- skeleton of the head and neck
-
cranial vault
- scalp (mnemonic)
-
sutures
- calvarial
- facial
- frontozygomatic suture
- frontomaxillary suture
- frontolacrimal suture
- frontonasal suture
- temporozygomatic suture
- zygomaticomaxillary suture
- parietotemporal suture (parietomastoid suture)
- occipitotemporal suture (occipitomastoid suture)
- sphenofrontal suture
- sphenozygomatic suture
- spheno-occipital suture
- lacrimomaxillary suture
- nasomaxillary suture
- internasal suture
- basal / internal
- skull landmarks
- frontal bone
- temporal bone
- parietal bone
- occipital bone
- skull base (foramina)
-
facial bones
- midline single bones
- paired bilateral bones
- cervical spine
- hyoid bone
- laryngeal cartilages
-
cranial vault
- muscles of the head and neck
- muscles of the tongue (mnemonic)
- muscles of mastication
- facial muscles
- muscles of the middle ear
- orbital muscles
- muscles of the soft palate
- pharyngeal muscles
- suprahyoid muscles
- infrahyoid muscles
- intrinsic muscles of the larynx
- muscles of the neck
- platysma
- longus colli muscle
- longus capitis muscle
- scalenus anterior muscle
- scalenus medius muscle
- scalenus posterior muscle
- scalenus pleuralis muscle
- sternocleidomastoid
-
suboccipital muscles
- rectus capitis posterior major muscle
- rectus capitis posterior minor muscle
- obliquus capitis superior muscle
- obliquus capitis inferior muscle
-
deep spaces of the neck
- infratemporal fossa
- pterygopalatine fossa
- visceral space
- suprasternal space (of Burns)
- retropharyngeal space
- perivertebral space
- parotid space
- parapharyngeal space
- pharyngeal (superficial) mucosal space
- masticator space
- deep cervical fascia
- danger space
- carotid sheath
- carotid space
- buccal space
- anterior cervical space
- surgical triangles of the neck
-
orbit
- bony orbit
- orbital spaces
- orbital septum
- eye movements
- orbital blood supply
- orbital nerve supply
- lacrimal apparatus
- ear
- paranasal sinuses
- nasal cavity
- oral cavity
- pharynx
- larynx
- viscera of the neck
- blood supply of the head and neck
-
arterial supply
-
common carotid artery
- carotid body
- carotid bifurcation
- subclavian artery
- variants
-
common carotid artery
- venous drainage
-
arterial supply
- innervation of the head and neck
-
cranial nerves
- olfactory nerve (CN I)
- optic nerve (CN II)
- oculomotor nerve (CN III)
- trochlear nerve (CN IV)
-
trigeminal nerve (mnemonic) (CN V)
- ophthalmic division
- maxillary division
- mandibular division
- abducens nerve (CN VI)
- facial nerve (CN VII)
- vestibulocochlear nerve (CN VIII)
- glossopharyngeal nerve (CN IX)
- vagus nerve (CN X)
- (spinal) accessory nerve (CN XI)
- hypoglossal nerve (CN XII)
- parasympathetic ganglia of the head and neck
- greater occipital nerve
-
cervical plexus
- muscular branches
- longus capitis
- longus colli
- scalenes
- geniohyoid
- thyrohyoid
-
ansa cervicalis
- omohyoid (superior and inferior bellies separately)
- sternothyroid
- sternohyoid
- phrenic nerve
- contribution to the accessory nerve (CN XI)
- cutaneous branches
- muscular branches
- brachial plexus
- pharyngeal plexus
-
cranial nerves
- lymphatic drainage of the head and neck
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