LN H&N boundaries

Question 1

Level 1a

Answer 1

submental:
between tongue (ant) and platysma (inf); bound laterally by anterior bellies of the digastrics

Question 2

level 1b

Answer 2

submandibular:
top of SMG to bottom of SMG, ant to symphysis menti, laterally to mandible/platysma, medial to digastric

Question 3

level II

Answer 3

Upper jugular
CC: caudal C1 lateral process to caudal hyoid
Medial: internal carotid
Ant: to submandibular gland and posterior belly of digastric
Lateral: SCM
Posterior: SCM

Question 4

level III

Answer 4

Middle jugular:
CC: caudal hyoid to caudal cricoid
Ant: SCM
Medial: internal carotid
Post: SCM
Lateral: SCM

Question 5

level IV (a+b)

Answer 5

A) lower jugular
CC: caudal cricoid to 2cm above sternal notch
Ant/lat/post: SCM
Medial: internal carotid

B) medial supraclav: 2cm above sternal notch to manubrium. Other boundaries same as above.

Question 6

level V: (a+b+c)

Answer 6

A/B: posterior triangle (upper/lower)
CC: Sup hyoid to inf transverse cervical vessels.
Ant: post edge of SCM
Post: trap
Medial: levator scapulae
Lateral: platysmus

C: lateral supraclav:
- From inf transverse vessels down to 2cm above sternal notch
- Lat/post to trapezius/clavicle, medially bound by IV A/B

Question 7

level VI

Answer 7

Anterior compartment. A: anterior jugular. B: pre-laryngeal/paratracheal
Cranial: A is caudal hyoid, B is caudal thyroid
Caudal: sternal manubrium
A: Mediolaterally: between SCM
B: space around airways bound by carotid arteries laterally

Question 8

level VII

Answer 8

VIIa: retropharyngeal
CC: superior edge of C1 to superior edge of hyoid
Ant: pharyngeal constrictors
Post: longus capitis
Lateral: medial edge of carotid (bc this is when jugular/lv II lymph nodes start)

VIIb: retrostyloid: NOTE: these are basically like LV II but just more superior
CC: from BOS to inf edge of C1
Ant: styloid process
Post: C1/BOS
Lateral: to deep edge of parotid
Medial: edge of carotid

Question 9

level VIII

Answer 9

Parotid. Think: 8 = ATE. I think an RC question asked the boundaries of the parotid…
CC: zygomatic arch to angle of mandible
Ant: masseter and medial pterygoid (inside mandible)
Post: SCM
Laterally: SMAS
Medially: styloid process

Question 10

level IX:

Answer 10

Bucco-facial (think: 9, Ten zebras broke my car): facial nerve
CC: inf edge of orbit to inf edge of mandible, space between skin and muscle (SMAS)

Question 11

Level X

Answer 11

Xa: retroauricular: from top of EAC down to mastoid tip, space between skin and bone
Xb: occipital: between occipital protuberance and sup edge of level V, ant to back edge of SCM and post to ant edge of trapezius (like V)