Lymph node levels of the neck

Lymph node levels of the neck

Level I  

• below myohyoid muscle and above the lower margin of the hyoid bone 
• anterior to the posterior border of the submandibular glands
• level Ia : sub mental - between the anterior bellies of the digastric muscle
• level Ib : sub mandibular - posterolateral to the anterior belly of digastric

Level II

• jugulodigastric 
• base of skull to lower margin of hyoid bone
• anterior to the posterior border of sternocleidomastoid (SCM)
• posterior to the posterior border of the submandibular glands
• level IIa : anterior, lateral, or medial to the vein or posterior to the internal jugular vein and inseparable from it.
• level IIb : posterior to the internal jugular vein and have a fat plane separating the nodes and the vein 

Level III

• middle jugular nodes
• lower margin of hyoid to lower margin of cricoid cartilage
• anterior to the posterior border of SCM
• lateral to the medial margin of the CCA / ICA

Level IV

• low jugular nodes 
• lower margin of cricoid cartilage to level of the clavicle
• anterior and medial to an oblique line drawn through the posterior edge of the sternocleidomastoid muscle and the posterolateral edge of the anterior scalene muscle⁴
• lateral to the medial margin of the CCA

Level V

• posterior triangle nodes
• level Va :  superior half, posterior to levels II and III
• level Vb :  inferior half, posterior to level IV

Level VI

• prelaryngeal / pretracheal / Delphian node
• from inferior margin of hyoid to manubrium
• in front of levels III and IV

Level VII 

• superior mediastinal 
• between CCAs, below top of manubrium