CERVICAL LYMPH NODE LEVELS

LEVEL I

Below mylohyoid muscle and above  lower margin of the hyoid bone (or carotid bifurcation) and anterior to the posterior border of the submandibular glands

       LEVEL Ia: Submental nodes - Between anterior bellies of digastric muscles

       LEVEL Ib: Submandibular nodes - Posterolateral to anterior belly of digastric muscles and anterior to posterior border of submandibular glands

LEVEL II

Base of the skull to the inferior border of hyoid bone (or the carotid bifurcation) and anterior to the posterior border of sternocleidomastoid (SCM) muscle and 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.  Most superior node is the jugulodigastric node

LEVEL IIb: Posterior to the internal jugular vein and have a fat plane separating the nodes and the vein

LEVEL III

Lower margin of hyoid to lower margin of cricoid cartilage (or the intermediate tendon of omohyoid) and anterior to posterior border of sternocleidomastoid muscle and lateral to medial margin of the CCA /ICA .

LEVEL IV

Lower margin of cricoid cartilage to level of the clavicle and anterior and medial to an oblique line drawn through posterior edge of SCM and the posterolateral edge of anterior scalene muscle and lateral to medial margin of CCA

LEVEL V

LEVEL Va: Superior half, posterior to levels II and III (between base of the skull and inferior border of cricoid cartilage)

LEVEL Vb: Inferior half, posterior to level IV (between the inferior border of cricoid cartilage and the level of clavicles)

LEVEL VI

From the inferior margin of hyoid bone to the manubrium and anterior to levels III and IV.

LEVEL VII

Between CCAs, below superior aspect of manubrium to level of the brachiocephalic vein.