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Lymph Node Levels of Neck
Lymph Node Levels of Neck
Surgically, cervical lymph nodes are divided into 6-7 levels (only 6 according to many
authors who exclude the level VII nodes) for staging of carcinoma which would also
be the basis for selective neck dissection. There are 5 levels in the lateral
compartment and 2 in the central compartment. Nodes not included in these system of
levels are retropharyngeal group, periparotid group, buccinator group, post auricular
group and suboccipital group of nodes.
II
III
A (Anterior to the
vertical line in
relation to spinal
accessory nerve)
B (Posterior to the
vertical line in
relation to spinal
accessory nerve)
Lymph nodes
Boundaries
Bilaterally: Anterior belly of digastrics
Submental nodes
Inferiorly: Hyoid bone
Superiorly: Mandible
Posteroinferiorly: Posterior belly of
Submandibular
digastrics
nodes
Anteroinferiorly: Anterior belly of
digastrics
Upper internal
jugular (deep
cervical) nodes
Mid internal
jugular (deep
cervical) nodes
IV
A (Above the
horizontal plane
marking the inferior
border of arch of
cricoids cartilage)
V
B (Below the
horizontal plane
marking the inferior
border of arch of
cricoids cartilage)
VI (Prelaryngeal or
Delphian, Pretracheal,
Paratracheal,
Prethyroidal)
VII
Lower internal
jugular (deep
cervical nodes)
Anterior
Superiorly: Hyoid boneInferiorly:
compartment
Suprasternal notchBilaterally: Carotid
(midline) nodes arteries
Upper
mediastinal
nodes
Note:
The highest jugular digastric node near the angle of the mandible is called the
sentinel node.
The signal node is the lowest along the internal jugular chain called the virchow
nodes.
Note: Bilateral nodes are common with cancers of soft palate, tongue, epiglottis, and
nasopharynx.
Selective Neck dissection involves: