Lymph node levels
The lymph nodes of the neck are divided into six different levels and six further sublevels according to their location and affiliation. The reason for this is that certain tumours spread specifically into certain groups of lymph nodes. In some cases, this results in the possibility of selective neck dissection.
In this case, only the most endangered levels of lymph nodes are removed to allow a smaller operation and fewer complications. The first level is the submental/submandibular level and is divided into the submental and submandibular sublevel. Submental refers to the area that is located centrally below the chin.
Submandibular is directly lateral to the submental sublevel and refers to the area below the jawbone. The second, third and fourth levels refer to the great cervical vein, the vena jugularis interna, which runs along the neck parallel to the carotid artery at an angle from the outside top to the inside bottom. The second level (craniojugular lymph node group) refers to the uppermost area of the vein in the neck and is divided into the medial (central) and lateral (lateral) sublevel.
The third level covers the medium height area of the neck vein and is also called the mediojugular lymph node group. The lowest part of the vena jugularis interna of the neck is represented by the fourth level and is also called the caudojugular level. The fifth level is the posterior neck triangle and represents the area to the side or behind the great vein.
It is divided into the cranial (upper) and caudal (lower) cervical triangle and thus represents the last two sublevels. The lymph nodes of the posterior cervical triangle are also called the accessory group, as they surround one of the major cranial nerves (nervus accessorius). The sixth and last level, in contrast to the fifth level, covers the front part of the neck, which is located in the middle of the large vein. The sixth level is also called the anterior compartment and contains the lymph nodes belonging to the pharynx (para- and retropharyngeal lymph node group).