Anatomy pearls
ANATOMY PEARLS
CERVICAL LYMPH NODE LEVELS
SOFT TISSUES OF THE NECK – LYMPH NODES
Level
Nodal group
Space occupied
Level I
Submental/submandibular nodes
Above the hyoid bone, below the mylohyoid muscle and anterior to the posterior aspect of the submandibular gland
Level IA
Submental nodes
Between the medial margins of the anterior bellies of the digastric muscles
Level IB
Submandibular nodes
Lateral to the level IA nodes and anterior to the posterior aspect of the submandibular gland
Level II
Upper internal jugular nodes
Anterior to the posterior aspect of the sternocleidomastoid muscle, posterior to the back of the submandibular gland, and above the base of the hyoid bone
Level IIA
A node that does not lie posterior to the internal jugular vein, or if it does is not separable from the vein
Level IIB
A node that lies posterior to the internal jugular vein with a fat plane separating it and the vein
Level III
Middle internal jugular nodes
Anterior to the posterior aspect of the sternocleidomastoid muscle, and between the base of the hyoid bone and the base of the cricoid arch
Level IV
Low internal jugular (Virchow) nodes
Anterior to a line connecting the posterior aspect of the sternocleidomastoid muscle and the posterolateral margin of the anterior scalene muscle, and between the base of the cricoid arch and the level of the clavicles
Level V
Posterior triangle nodes
From the skull base to the level of the clavicle, anterior to the anterior margin of the trapezius muscle, and posterior to the posterior aspect of the sternocleidomastoid muscle
Level VA
Above the level of the base of the cricoid arch
Level VB
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an irregular outline 
a heterogeneous internal pattern
