Level of Head and Neck Scheme of Lymphonode Groups

 

 

 

Level IA: Submental Group Lymph nodes within the triangular boundary of the anterior belly of the digastric muscles and the hyoid bone.
Level IB: Submandibular Group Lymph nodes within the boundaries of the anterior and posterior bellies of the digastric muscles, the stylohyoid muscle, and the body of the mandible (posteriorly to submandibular gland). The group includes the pre- and postglandular nodes, and the pre- and postvascular nodes.

Levels IIA & IIB: Upper Jugular Group Lymph nodes located around the upper third of the internal jugular vein and adjacent spinal accessory nerve extending from the level of the skull base (above) to the level of the inferior border of the hyoid bone (below). The anterior (medial) boundary is the lateral border of the sternohyoid muscle and the stylohyoid muscle (or posterior aspect of the submandibular gland when assessed radiographically), and the posterior (lateral) boundary is the posterior border of the sternocleidomastoid muscle. Sublevel IIA nodes are located anterior (medial) to the vertical plane defined by the spinal accessory nerve. Sublevel IIB nodes are located posterior (lateral) to the vertical plane defined by the spinal accessory nerve.

Level III: Middle Jugular Group Lymph nodes located around the middle third of the internal jugular vein extending from the inferior border of the hyoid bone (above) to the inferior border of the cricoid cartilage (below). The anterior (medial) boundary is the lateral border of the sternohyoid muscle, and the posterior (lateral) boundary is the posterior border of the sternocleidomastoid muscle. (Included in this group is the jugulo-omohyoid node, which lies immediately above the superior belly of the omohyoid muscle as it crosses the internal jugular vein.)

Level IV: Lower Jugular Group Lymph nodes located around the lower third of the internal jugular vein extending from the inferior border of the cricoid cartilage (above) to the clavicle (below). The anterior (medial) boundary is the lateral border of the sternohyoid muscle, and the posterior (lateral) boundary is the posterior border of the sternocleidomastoid muscle. (Virchow).

Levels VA & VB: Posterior Triangle Group This group is comprised predominantly of the lymph nodes located along the lower half of the spinal accessory nerve and the transverse cervical artery. The supraclavicular nodes are also included in the posterior triangle group. The superior boundary is the apex formed by a convergence of the sternocleidomastoid and the trapezius muscles, the inferior boundary is the clavicle, the anterior (medial) boundary is the posterior border of the sternocleidomastoid muscle, and the posterior (lateral) boundary is the anterior border of the trapezius muscle. Sublevel VA is separated from Sublevel VB by a horizontal plane marking the inferior border of the arch of the cricoid cartilage. Sublevel VA includes the spinal accessory nodes, and Sublevel VB includes the nodes following the transverse cervical vessels and the supraclavicular nodes.

Level VI: Anterior Central Compartment Group Lymph nodes in this compartment include the pre- and paratracheal nodes, the precricoid (Delphian) node, and the perithyroidal nodes, including the lymph nodes along the recurrent laryngeal nerves. The superior boundary is the hyoid bone, the inferior boundary is the suprasternal notch, and the lateral boundaries are the common carotid arteries.

 

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