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Lymph Node Groups (Levels)

last modified on: Tue, 02/20/2024 - 09:09

Lymph Node Groups

IA
Submental

- Between anterior belly of the digastric and hyoid
- Drains the floor of mouth, anterior oral tongue, anterior mandibular alveolar ridge, and lower lip.

IB
Submandibular

- Between anterior and posterior bellies of the digastric, the stylohyoid, and the body of the mandible.
- Radiographically, the vertical plane at the posterior aspect of the submandibular gland separates posterior IB from IIA

IIa & IIB
Upper jugular

- Upper third of IJ from the skull base (above) to the inferior border of the hyoid (below); lateral border of the sternohyoid and the stylohyoid (medial) to the posterior border of the SCM (lateral).*
- Sublevel IIA and IIB nodes are divided by the spinal accessory nerve.
- Drains the oral cavity, nasal cavity, nasopharynx, oropharynx, hypopharynx, larynx, and parotid gland.

III
Middle jugular

- Middle third of IJ from the inferior border of the hyoid bone (above) to the inferior border of the cricoid cartilage (below); lateral border of the sternohyoid (medial) to the posterior border of the SCM (lateral).*
- Drains the oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx.

IVA & IVB
Lower jugular

- Lower third of IJ from the inferior border of the cricoid cartilage (above) to the clavicle (below); lateral border of the sternohyoid (medial) to the posterior border of the SCM (lateral).*
- Drains the hypopharynx, cervical esophagus, and larynx.

- IVA is separated from IVB by the deep surface of the sternocleidomastoid muscle

VA & VB
Posterior cervical

- Along lower half of CN XI and the transverse cervical artery. From the convergence of the SCM and trapezius (above) to the clavicle (below); the posterior border of the (medial),* to the anterior border of the trapezius (lateral).
- Sublevels VA and VB separated by a horizontal plane at the inferior border of the cricoid cartilage.
- Drains the nasopharynx and oropharynx (Sublevel VA), and the thyroid gland (Sublevel VB).

VI
Anterior, visceral

- Between the hyoid bone (above) to the suprasternal notch (below), and the common carotid arteries.
- Drains the thyroid gland, glottic and subglottic larynx, apex of the piriform sinus, and cervical esophagus.

VII
Superior mediastinal

- Top of manubrium (above) to innominate vein (below); between common carotid arteries laterally

* The surgical landmark that defines the lateral boundary of Levels II, III, and IV and the corresponding medial boundary of the posterior triangle (Level V) is the plane that parallels the sensory branches of the cervical plexus.

References

Grégoire V, Ang K, Budach W, Grau C, Hamoir M, Langendijk JA, Lee A, Le QT, Maingon P, Nutting C, O'Sullivan B, Porceddu SV, Lengele B. Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol. 2014 Jan;110(1):172-81. doi: 10.1016/j.radonc.2013.10.010. Epub 2013 Oct 31. PMID: 24183870.

Pagedar NA, Hoffman HT. Anatomic Variability of the Accessory Nerve: Implications for Dissection of Level IIB. Laryngoscope. 2024 Jan;134(1):154-159. doi: 10.1002/lary.30758. Epub 2023 Jun 8. PMID: 37289066; PMCID: PMC10703995.

Iwanaga J, Lofton C, He P, Dumont AS, Tubbs RS. Lymphatic System of the Head and Neck. J Craniofac Surg. 2021 Jul-Aug 01;32(5):1901-1905. doi: 10.1097/SCS.0000000000007230. PMID: 33201067.