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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.
Superiorly: Mandible
Posteroinferiorly: Posterior belly of
digastrics
Anteroinferiorly: Anterior belly of
I B Submandibular nodes digastrics
Upper mediastinal
VII nodes Below suprasternal notch
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.
Probable source of Nodal metastasis:
Level 1: Oral cavity, submandibular gland
Level 2: Nasopharynx, oropharynx, parotid, supraglottic larynx
Level 3: Oropharynx, hypopharynx, supraglottic larynx
Level 4: Subglottic larynx, hypopharynx, esophagus, thyroid
Level 5: Nasopharynx, oropharynx
Level 6 & 7: Thyroid, larynx, lung
Note: Bilateral nodes are common with cancers of soft palate, tongue, epiglottis, and
nasopharynx.