The Radiology Assistant: Cervical Lymph Node Map (2023)

In this cervical lymph node map, the levels have been expanded to 10.

Some of them are divided into sublevels for more complete alignment with the TNM atlas.

Limits

Important milestones are:

• hyoid bone
• cricoid
• carotid arteries
• sternocleidomastoid muscle
• open from outside

I - Submentual e submandibular

Stage I nodules are at risk of developing metastases from cancers of the oral cavity, anterior nasal cavity, and soft tissues of the midface and submandibular gland.

a stove
It is a midline region between the anterior belly of the digastric muscles, which contains the submental ganglia.

level one
It contains the submandibular ganglia located in the space between the medial surface of the mandible laterally and the medial digastric muscle, from the chin of the anterior symphysis to the posterior submandibular gland.

II - superior carotid artery

Level II receives lymphatics from the face, parotid gland, and submandibular, submental, and retropharyngeal lymph nodes.
Level II also directly receives collecting lymphatics from the nasal cavity, pharynx, larynx, external auditory canal, middle ear, and sublingual and submandibular glands.[1].

Level II can be divided into level IIa and level IIb by drawing a line on the posterior border of the internal jugular vein.

Level IIa and IIb lymph nodes are at risk for harboring metastases from cancers of the nasal and oral cavity, nasopharynx, oropharynx, hypopharynx, larynx, and major salivary glands.

Grade IIb is more associated with primary tumors of the oropharynx or nasopharynx, more rarely with tumors of the oral cavity, larynx or hypopharynx.[1].

III - Jugular eyes

Level III receives efferent lymphatics from levels II and V and some efferent lymphatics from retropharyngeal, pretracheal, and recurrent laryngeal nodes.
It collects lymphatic vessels from the base of the tongue, tonsils, larynx, hypopharynx, and thyroid.

The inferior border of the cricoid is the border between Level III and the IVA.

Stage III nodules are at risk for harboring metastases from cancers of the oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx.

IV - Jugular inferior e supraclavicular medial

The limit between levels IVa and IVb is arbitrarily fixed 2 cm above the sternoclavicular joint.

IV stoves
These lymph nodes are at risk for harboring metastases from cancers of the hypopharynx, larynx, thyroid, and cervical esophagus.
Rarely, anterior oral cavity metastases may manifest in this site with minimal or no proximal lymph node disease.

Estádio IVb
These nodules are at risk for harboring metastases from cancers of the hypopharynx, subglottic larynx, trachea, thyroid, and cervical esophagus.

V - posterior and supraclavicular triangle

Level V contains the ganglia of the posterior triangular group, located behind the sternocleidomastoid muscle around the lower part of the accessory nerve and cervical transverse vessels.

Level V nodules are most commonly associated with primary cancers of the nasopharynx, oropharynx, cutaneous structures of the posterior scalp, and thyroid.

Plano Vc - Supraclavicular

This plane contains the lateral supraclavicular ganglia, which lie in continuation of the posterior triangular ganglia (levels Va and Vb) from the cervical transverse vessels to a ridge arbitrarily placed 2 cm cranial to the manubrium of the sternum.
It partially corresponds to the area known as the supraclavicular fossa.

Level Vc receives efferent lymph from the posterior triangular lymph nodes (levels Va and Vb) and is most commonly associated with nasopharyngeal tumors.[1].

transverse cervical artery
Scroll through images of the anatomy of the transverse carotid artery.

VI - Anterior cervical vertebra

This level contains the superficial anterior jugular nodes (level VIa) and the deeper prelaryngeal, pretracheal, paratracheal, and recurrent laryngeal nodes (level VIb).

Level VIa
This level contains the superficial anterior jugular lymph nodes.

Nivel VIb
This plane is contained between the medial borders of the common carotid arteries.
The nodes in this area are:

• Pre-laryngeal node anterior to the larynx and cricoid cartilage
• pretracheal nodules in front of the trachea
• Paratracheal nodules, also called recurrent laryngeal nodules

Delphi lymph node

The Delphi lymph node derives its name from the Oracle of Delphi, which was prophesied to be fatal secondary throat cancer.

It is a pretracheal nodule at level VIa, located anterior to the cricoid and between the cricothyroid muscles.

The recurrent laryngeal nerves branch off the vagus, to the left into the aortic arch and to the right into the right subclavian artery.

The left laryngeal nerve can be compressed by subaortic lymph node metastases at the aortopulmonary window, as seen in patients with lung cancer.

VII - Retropharyngeal and retrostyloid

The retropharyngeal nodes receive lymphatics from the nasopharyngeal mucosa, Eustachian tube, and soft palate.

These lymph nodes are at risk for harboring metastases from cancers of the nasopharynx, posterior pharyngeal wall, and oropharynx (mainly the tonsillar fossa and soft palate).

Stufe VIIa - retropharyngeal

These lymph nodes are located in the retropharyngeal space and extend cranially from the superior border of the first cervical vertebra (Massa lateralis) to the superior border of the body of the hyoid bone (Figure).

This space is delimited anteriorly by the pharyngeal constrictor muscles and posteriorly by the longus head and longus neck muscles.
Laterally, the retropharyngeal lymph nodes are bounded by the medial border of the internal carotid artery.

The retropharyngeal nodes receive efferent lymphatics from the nasopharyngeal mucosa, Eustachian tube, and soft palate.
These lymph nodes are at risk for harboring metastases from cancers of the nasopharynx, posterior pharyngeal wall, and oropharynx (mainly the tonsillar fossa and soft palate).

Stufe VIIb - retroestiloideo

The retrostyloid ganglia are the cranial continuation of the level II ganglia.
They are located in the fatty space around the jugulocarotid vessels to the base of the skull at the jugular foramen.

VIII - parotid gland

This level contains the parotid lymph node group, which includes the subcutaneous preauricular lymph nodes, the superficial and deep intraparotid lymph nodes, and the subparotid lymph nodes.

These nodules extend from the zygomatic arch and external acoustic meatus to the mandible.

They extend medially from the subcutaneous tissue laterally to the styloid process and anteriorly from the posterior border of the masseter and pterygoid muscles to the anterior border of the sternocleidomastoid and the posterior belly of the digastric muscle posteriorly.[1].

The parotid group receives lymph from the frontal and temporal skin, eyelids, conjunctiva, pinna, external auditory canal, tympanic membrane, nasal cavities, root of the nose, nasopharynx and Eustachian tube.

They are at risk of harboring metastases from cancers of the frontal and temporal skin, orbit, external auditory canal, nasal cavities and parotid gland.

IX - Bucofacial

Level IX contains the malar and orofacial node group, which includes inconsistent superficial lymph nodes around the facial vessels on the outer surface of the buccinator muscle.
These lymph nodes extend from the caudal border of the orbit (cranial) to the caudal border of the mandible (caudal), where they reach level Ib.

They are located above the buccinator muscle (medial) in the subcutaneous tissue, from the anterior border of the masseter muscle and Bichat fat (posterior) to the anterior subcutaneous tissue of the face.

The orofacial ganglia receive efferent vessels from the nose, eyelids, and cheeks.

They are at risk of harboring cancer metastases of the face, nose, maxillary sinus (invading the soft tissue of the cheek) and buccal mucosa.

X - Retroauricular e occipital

Level Xa includes the retroauricular (also called mastoid) and subauricular nodes, which include superficial nodules found on the mastoid from the cranial border of the external auditory canal cranially to the tip of the mastoid caudally.

Level Xb contains the occipital lymph nodes, which are the cranial and superficial continuation of the lymph nodes from level Va to the pons. They lie from the posterior border of the sternocleidomastoid muscle to the anterior (lateral) border of the trapezius muscle.