Cervical Lymph Nodes of the Neck

Mar 17, 2021 3 min read
Cervical Lymph Nodes of the Neck

Cervical Lymph Nodes of the neck can provide diagnostics clues to the origin of the pathology. There are a total of 7 levels, which this article discusses.

Overview​​​​​​​​​​​​​​

Cervical Lymph nodes of the neck can be classified into 7 levels based on specific anatomical landmarks. These levels can provide diagnostic clues to the origin of lymphadenopathy and guides surgical intervention.

Cervical Lymph Nodes Anatomy

Drainage Pattern of Cervical Lymph Nodes



Level I Cervical Lymph Nodes

This nodal level can be subdivided into 1A (submental) and 1B (submandibular)

Drains from the lips, gum, teeth, tongue, anterior hard palate. The submandibular gland duct, or Whartons Duct, ends in the floor of mouth and is typically blocked when cancer invades in this area. This results in a firm collection of savilary content. This finding can be also found in an englarged node.

Landmarks are:

  • superiorly: mylohyoid muscle and mandible
  • inferiorly: inferior border of the hyoid bone
  • anteriorly: platysma muscle
  • posteriorly: posterior border of the submandibular gland
Anterior View of Levels IA and IB

Level II Cervical Lymph Nodes

This is called the upper jugular group.

Drains the naso-/oro-/hypopharynx and parotid.

Landmarks are:

  • superiorly: base of the skull at the jugular fossa
  • inferiorly: inferior border of the hyoid bone
  • anteriorly: posterior border of the submandibular gland
  • posterolaterally: posterior border of the sternocleidomastoid muscle
  • medially: medial border of the internal carotid artery
Levels II and III along the sternocleidomastoid muscle


Level III Cervical Lymph Nodes

This is called the middle jugular group.

Drains the naso-/oro-/hypopharynx and larynx.

Landmarks are:

  • superiorly: inferior border of the hyoid bone
  • inferiorly: inferior border of the cricoid cartilage
  • anteriorly: anterior border of the sternocleidomastoid muscle
  • posterolaterally: posterior border of the sternocleidomastoid muscle
  • medially: medial border of the common carotid artery
Level III Cervical Nodes and nearby muscle bellies.

Level IV Cervical Lymph Nodes

This is called the lower jugular group. It includes medial supraclavicular nodes including Virchow node

Drains the larynx, cervical esophagus, hypopharynx

Landmarks are:

  • superiorly: inferior border of the cricoid cartilage
  • inferiorly: level of the clavicle
  • anteriorly: anterior border of the sternocleidomastoid muscle
  • posterolaterally: oblique line drawn through the posterolateral edge of the sternocleidomastoid muscle and the lateral edge of the anterior scalene muscle
  • medially: medial border of the common carotid artery

Level V Cervical Lymph Nodes

This is called the posterior triangle group.

Drains the naso- and oro-pharynx.

Landmarks are:

  • superiorly: skull base at the apex of the convergence of sternocleidomastoid and trapezius muscles
  • inferiorly: level of the clavicle
  • anteromedially: posterior border of the sternocleidomastoid muscle
  • posterolaterally: anterior border of the trapezius muscle
Level 5 Cervical Nodes and nearby structures

Level VI Cervical Lymph Nodes

This is called the anterior central group below the hyoid and sternal notch.

Drains the thyroid, parathyroid, cervical esophagus, larynx. More posteriorly, the hard palate and soft palate will drain the retropharyngeal space and deep cervical nodes.

Landmarks are:

  • superiorly: inferior border of hyoid bone
  • inferiorly: superior border of manubrium (suprasternal notch)
  • anteriorly: platysma muscle
  • posteriorly: trachea (medially) and prevertebral space (laterally)
  • laterally: medial borders of both common carotid arteries (medial to levels III and IV)
Level VI Cervical Lymph Nodes

Level VII Cervical Lymph Nodes

Level VII nodes are referred to as “upper mediastinal” nodes

These nodes contained within the area made up of the carotid arteries laterally, the suprasternal notch superiorly, and the aortic arch inferiorly.

Level VII Cervical Lymph Nodes

Radiological Findings


References

  1. 1. Haynes J, Arnold K, Aguirre-Oskins C, Chandra S. Evaluation of neck masses in adults. Am Fam Physician. 2015;91(10):698-706. https://www.ncbi.nlm.nih.gov/pubmed/25978199.
  2. 2. Robbins K, Shaha A, Medina J, et al. Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg. 2008;134(5):536-538. doi:10.1001/archotol.134.5.536
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