Lymph of Head/Neck

Question 1

Lymph from oral cavity and nasopharynx likes to…

Answer 1

Cross the midline -> oral cancer metastasize to lymph nodes bilaterally

Question 2

Deep cervical nodes are…

Answer 2

Situated along internal jugular vein

Question 3

Superior deep cervical are near…

Answer 3

Posterior belly of digastric muscles

Question 4

Inferior deep cervical are near…

Answer 4

Omohyoid

Question 5

Level I lymph

Answer 5

Submental and submandibular triangles, includes submental and sublingual nodes

Question 6

Where does level I receive lymph?

Answer 6

Lips, face, oral cavity, anterior nasal cavity, submandibular gland

Question 7

Where does level I drain?

Answer 7

Levels II + III

Question 8

What is lymphadenopathy in level I associated with?

Answer 8

Disease of the oral cavity (tongue, lips), anterior nasal cavity, face (melanoma), lymphomas and leukemia

Question 9

Level II lymph

Answer 9

Boundaries are base of the skull, posterior border of the SCM and level of the hyoid bone (~upper 1/3 of SCM); includes the superior deep cervical nodes (JD nodes)

Question 10

Where does level II lymph receive lymph from?

Answer 10

Auricle, nasal cavity, oral cavity (palatine tonsil – tonsillitis!),
pharynx, larynx, parotid (nodes + gland), suboccipital nodes, retropharyngeal nodes and level I

Question 11

Where does level II lymph drain?

Answer 11

Levels III - V

Question 12

What is lymphadenopathy in level II indicate?

Answer 12

Disease of auricle, oral/nasal cavity, pharynx, larynx, thyroid gland, parotid gland

Question 13

What is level III lymph?

Answer 13

Boundaries are level of the hyoid bone to inferior border of the cricoid cartilage and posterior border of the SCM (~middle 1/3 of SCM); includes nodes along the middle 1/3 of the internal jugular vein

Question 14

What does level III receive lymph from?

Answer 14

Oral cavity, levels I + II

Question 15

Where does lymph from level III drain to?

Answer 15

Level IV

Question 16

Level IV lymph

Answer 16

boundaries are level of the cricoid cartilage to clavicle and posterior border of the SCM (~lower 1/3 of SCM); includes the inferior deep cervical nodes (JO nodes)

Question 17

Where does level IV receive lymph from?

Answer 17

Level I, level III, posterior scalp and paratracheal nodes

Question 18

Where does level IV drain?

Answer 18

Thoracic duct + R lymphatic duct

Question 19

What does lymphadenopathy in level IV associated with?

Answer 19

Disease of the oral cavity, larynx, and thyroid gland; usually via spread from level I (submental nodes), level III or paratracheal nodes

Question 20

Level V

Answer 20

Posterior triangle of the neck; includes the posterior cervical and supraclavicular nodes

Question 21

Where does level V receive lymph from?

Answer 21

Posterior scalp (suboccipital nodes), nasopharynx, retropharyngeal nodes, axillary nodes and levels II – III

Question 22

Where does level V drain?

Answer 22

IV

Question 23

Lymphadenopathy in level V indicates…

Answer 23

the posterior cervical nodes is associated with infections of the posterior scalp
 Lymphadenopathy in the supraclavicular nodes is associated with abdominal/thoracic
neoplasia (see Virchow’s node), thyroid, laryngeal cancer; distant metastasis (from ovary, prostate, testicle)

Question 24

Level VI

Answer 24

Anterior midline between hyoid and sternal notch; includes prelaryngeal, pretracheal and paratracheal nodes

Question 25

Where does level VI receive lymph from?

Answer 25

Larynx, laryngopharynx, thyroid, trachea, cervical esophagus

Question 26

Where does level VI drain?

Answer 26

Level II - IV

Question 27

Level VII

Answer 27

Anterior midline below sternal notch; includes superior mediastinal nodes