This document describes the 7 levels of cervical lymph nodes in the neck. It provides details on the boundaries, drainage patterns, and involved pathology for each level. The levels extend from the skull base superiorly to the clavicle inferiorly. Each level contains specific nodal groups and may have sublevels. The document defines the clinical, radiologic, and surgical boundaries for each lymph node level to aid in neck dissection and evaluation of cervical lymphadenopathy.
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Cervical Lymph Nodes Anatomy
1. CERVICAL LYMPH NODES
Dr. Diptiman Baliarsingh
1st Year PG, Dept. of ENT,
Hi-Tech Medical College & Hospital, Bhubaneswar
2. Introduction
The cervical group of lymph nodes extend from
Mandible & skull base superiorly
Clavicle inferiorly
Posterior triangle of neck laterally & posteriroly
Midline viscera anteriorly
LN groups are categorized acc to original
description by Memorial Sloan-Kettering Group
3. Levels of Neck Nodes
There are 7 levels of neck and most have
sublevels containing specific group of nodes
Level I – Submental & Submandibular
Level II – Upper Jugular
Level III – Middle Jugular
Level VI – Lower Jugular
Level V – Posterior Triangle
Level VI – Anterior/Central Compartment
Level VII – Superior Mediastinal
4.
5.
6. LEVEL I
2 groups of LN’s
Sublevel Ia – Submental
Sublevel Ib – Submandibular
Boundaries of Lvl I
Body of Mandible
Ant. Belly of C/L digastric muscle
Post. Belly of I/L digastric muscle
Stylohyoid muscle
7. Submental (Sublevel Ia)
LN’s in the triangular boundary formed by
Ant belly of digastric muscles
Hyoid Bone
Involved in pathology of
Floor of mouth
Anterior oral tongue
Anterior mandibular alveolar ridge
Lower lip
8.
9.
10. Boundary Clinical Radiologic Surgical
LEVEL Ia
Superior
Inferior
Lateral
(Posterior)
Medial
Symphisis of
mandible
Body of Hyoid
N/A
N/A
Geniohyoid
Muscle,
Plane tangent to
inf. Border of
mandible
Body of Hyoid
Ant belly of I/L
digastric mus.
Ant belly of C/L
digastric muscle
Symphisis of
mandible
Body of Hyoid
Ant belly of I/L
digastric mus.
Ant belly of C/L
digastric muscle
11. Submandibular (Sublevel Ib)
LN’s in the triangular boundary formed by
Ant belly of digastric muscle
Stylohyoid & Post belly of digastric muscle
Body of Mandible
Involved in pathology of
Oral Cavity
Anterior Nasal Cavity
Soft tissue structures of midface
Submandibular gland
12.
13. Boundary Clinical Radiologic Surgical
LEVEL Ib
Superior
Inferior
Lateral
(Posterior)
Medial
Body of mandible
Plane through
Hyoid bone
Ant border of SCM
N/A
Mylohyoid Mus,
Body of mandible
Inferior edge of
hyoid bone
Post edge of
Submandibular Gl.
Ant belly of
digastric muscle
Body of mandible
Digastric tendon
attachment to
hyoid bone
Post edge of
Submandibular Gl
Ant belly of
digastric muscle
14. Many of these lymph nodes lie in close proximity
to submandibular gland, and it is removed to
ensure thorough exenteration of all lymph nodes
with in this traingle
Perifacial LN’s – drain Lip, buccal musoca, ant
nasal caity & soft tissue of neck, sometimes get
involved along with the Level I LN groups.
ND’s performed for nodal disease asso with
primary lesions of these sites should be modified
to encompass perifacial nodes
15. LEVEL II
Contain Upper Jugular LN’s
2 groups – Sublevel IIa & IIb
LN’s are located around upper third of internal
jugular vein & adjacent spinal accessory nerve
Extent
Superiorly - Skull base
Inferirly - Inf border of Hyoid bone
Ant (medial) boundary – stylohyoid mus
Post (lateral) boundary – posterior border of SCM
16. Sublevel IIa nodes are located anterior (medial)
to vertical plane defined by spinal accessory
nerve, whereas sublevel IIb nodes are located
posterior (lateral) to the vertical plane defined by
spinal accessory nerve
Involved in pathology of
Oral cavity, Nasal Cavity
Nasopharynx, Oropharynx, Hypopharynx
Larynx
Parotid gland
17.
18. Boundary Clinical Radiologic Surgical
LEVEL IIA
Superior
Inferior
Lateral
(Posterior)
Medial
Mastoid process
Horizontal plane
defined by the
inferior border of
hyoid bone
N/A
N/A
Skull base,
Caudal edge of
C1 lateral process
Horizontal plane
defined by the
inferior border of
hyoid bone
Post. border of IJV
Post. edge of
submandibular
gland
Skull base
Carotid bifurcation
Vertical plane
defined by Spinal
acc. nerve
Post. edge of
submandibular
gland
19.
20. Boundary Clinical Radiologic Surgical
LEVEL IIB
Superior
Inferior
Lateral
(Posterior)
Medial
Mastoid process
Horizontal plane
defined by the
inferior border of
hyoid bone
Lateral border of
SCM
N/A
Skull base,
Caudal edge of
C1 lateral process
Horizontal plane
defined by the
inferior border of
hyoid bone
Lateral border of
SCM
Medial edge of
ICA, paraspinal
(lev. scapulae)
mus
Skull base
Carotid bifurcation
Lateral border of
SCM
Vertical plane
defined by Spinal
acc. nerve
21. AHNS Committee recommends – perpendicular
plane formed by posterior aspect of
submandibular gland as radiologic marker of this
boundary
22. LEVEL III
Contains Middle Jugular LN’s Group
Located around middle third of IJV
Extent
Superiorly – Carotid bifurcation / Inferior aspect of
body of hyoid bone
Inferiorly – Junction of Omohyoid mus with IJV / lower
border of cricoid arch(cartilage)
Medially – Lateral border of sternohyiod muscle
Laterally – Post border of SCM muscle
23. Involved in pathology of
Oral cavity
Nasopharynx, Oropharynx, Hypopharynx
Larynx
AHNS Committee recommends – Lateral border
of CCA serves as Radiologic marker for medial
boundary
24.
25. Boundary Clinical Radiologic Surgical
LEVEL III
Superior
Inferior
Lateral
(Posterior)
Medial
Horizontal plane
defined by the
inferior border of
hyoid bone
Horizontal plane
defined by the
inferior border of
cricod cartilage
Lateral border of
SCM
Medial border of
SCM
Horizontal plane
defined by the
inferior border of
hyoid bone
Horizontal plane
defined by the
inferior border of
cricod cartilage
Lateral border of
SCM
Medial edge of
ICA, paraspinal
(lev. scapulae)
mus
Carotid bifurcation
Omohyoid muscle
Sensory branches
of cervical plexus
Sternohyoid
muscle
26. LEVEL IV
Contains Lower Jugular LN’s Group
Located around lower third of IJV
Extent
Superiorly – Junction of Omohyoid mus with IJV /
lower border of cricoid arch(cartilage)
Inferiorly – Clavicle
Medially – Lateral border of sternohyiod muscle
Laterally – Post border of SCM muscle
27. Involved in pathology of
Hypopharynx
Thyroid
Cervical Esophagus
Larynx
AHNS Committee recommends – Lateral border
of CCA serves as Radiologic marker for medial
boundary
28.
29. Boundary Clinical Radiologic Surgical
LEVEL IV
Superior
Inferior
Lateral
(Posterior)
Medial
Horizontal plane
defined by the
inferior border of
cricod cartilage
Clavicle
Lateral border of
SCM
Medial border of
SCM
Horizontal plane
defined by the
inferior border of
cricod cartilage
2cm cranial to
sternoclavicular
joint
Lateral border of
SCM
Medial edge of
CCA, paraspinal
(scalenus) mus
Omohyoid muscle
Clavicle
Sensory branches
of cervical plexus
Sternohyoid
muscle
30. LEVEL V
Contains Posterior Triangle LN’s Group
Located along the lower half of spinal accessory
nerve & transverse cervical artery
Extent
Superiorly (Apex) – convergence of SCM & trapezius
muscle
Inferiorly – Clavicle
Medially – Post border of SCM muscle
Laterally – Anterior border of trapezius muscle
31. 2 groups – Sublevel Va & Vb
The Va is separated from Vb by a horizontal plane
marking the inferior border of the anterior cricod
arch
Sublvl Va includes – Spinal accessory nodes
Sublvl Vb includes – nodes following transverse
cervical vessels & supraclavicular nodes (not
Virchow’s Nodes – they are located in Level IV)
32. Involved in pathology of
Nasopharynx
Oropharynx
Cutaneous structures of posterior scalp
Neck
33.
34. Boundary Clinical Radiologic Surgical
LEVEL Va
Superior
Inferior
Lateral
(Posterior)
Medial
Apex of
convergence of
SCM & trapezius
muscle
Horizontal plane
defined by the
inferior border of
cricod cartilage
Anterior border of
Trapezius muscle
Lateral border of
SCM
Apex of
convergence of
SCM & trapezius
muscle
Horizontal plane
defined by the
inferior border of
cricod cartilage
Anterior border of
Trapezius muscle
Lateral border of
SCM
Apex of
convergence of
SCM & trapezius
muscle
Horizontal plane
defined by the
inferior border of
cricod cartilage
Anterior border of
Trapezius muscle
Sensory branches
of cervical plexus
35.
36. Boundary Clinical Radiologic Surgical
LEVEL Vb
Superior
Inferior
Lateral
(Posterior)
Medial
Horizontal plane
defined by the
inferior border of
cricod cartilage
Clavicle
Anterior border of
Trapezius muscle
Lateral border of
SCM
Horizontal plane
defined by the
inferior border of
cricod cartilage
Clavicle
Anterior border of
Trapezius muscle
Lateral border of
SCM
Horizontal plane
defined by the
inferior border of
cricod cartilage
Clavicle
Anterior border of
Trapezius muscle
Sensory branches
of cervical plexus
37. LEVEL VI
Contains LN’s of Anterior compartment of the
neck
They surround the midline visceral structures of
the neck
Extent
Superiorly – Hyoid Bone
Inferiorly – Suprasternal Notch
Laterally (on each side) – Medial border of Carotid
sheath
38. LN groups in the compartment are –
Pretracheal N
Paratracheal N
Precricoid (Delphian) N
Perithyroidal N
LN’s along Recurrent Laryngeal Nr
Involved in pathology of
Thyroid Gland
Glottic & Subglottic Larynx
Apex of pyriform sinus
Cervical esophagus
39.
40. Boundary Clinical Radiologic Surgical
LEVEL VI
Superior
Inferior
Lateral
(Posterior)
Medial
Hyoid Bone
Superior edge of
manubrium sterni
CCA
CCA
Hyoid Bone
Superior edge of
manubrium sterni
Medial Aspect of
CCA
Medial Aspect of
CCA
Hyoid Bone
Superior edge of
manubrium sterni
CCA
CCA
41. LEVEL VII
Contains Superior Mediastinal group of LN’s
The LN are an extension of the paratracheal LN
chain extending inferiorly below the suprasternal
notch along each side of cervical trachea to the
level of the innominate artery
Extent
Superiorly – Superior edge of manubrium
Inferiorly – superior border of arch of aorta
Laterally (Left side) – CCA
Laterally (Right side) – Innominate Artery
42.
43. Boundary Clinical Radiologic Surgical
LEVEL VII
Superior
Inferior
Lateral
(Posterior)
Medial
Superior edge of
manubrium sterni
N/A
N/A
N/A
Superior edge of
manubrium sterni
Innominate Artery
Innominate Artery
& Left CCA
Innominate Artery
& Left CCA
Superior edge of
manubrium sterni
Innominate Artery
Innominate Artery
& Left CCA
Innominate Artery
& Left CCA