eRadiograph Volume 7: Imaging of Oral Cavity | Page 346

Cervical lymph nodes
Assessment of pathologies of the neck spaces is always accompanied with an
assessment of the cervical lymphadenopathy to determine spread of disease and its
extent.
Cervical lymph nodes may be reactive, due to granulomatous process, lymphoma or
secondary to head and neck malignancies.
Cervical lymph nodes are classified into 7 nodal levels.
Level 1 lymph nodes lie inferior to the mylohyoid muscle and are divided into two
groups 1A and 1B by the anterior belly of the digastric. 1A are medial and 1B are lateral
to the anterior belly of the digastric.
Level II lymph nodes lie between the base of the skull and the hyoid bone anterior to
the sternocleido mastoid muscle. These are further divided into IIA and IIB – IIA lymph
nodes are in contact with the jugular vein or anterior to the jugular vein. IIB
adenopathy are posterior to the jugular vein.
Level III adenopathy are between the hyoid bone and cricoid cartilage lateral to
carotid artery and anterior to sternocleido mastoid muscle.
Level IV lymph nodes lie between the cricoid cartilage and clavicle, lateral to carotid
artery, anterior to sternocleido mastoi d.
Level V lymph nodes are posterior to the sternocleido mastoid muscle from skull
base to clavicle. These are divided in VA and VB – VA between skull base and cricoid,
VB between cricoid and clavicle.
Level VI are adenopathy medial to both carotid arteries from the hyoid to upper
margin of manubrium.

There are certain nodal sites which do not fit into this classification, they are
intraparotid, buccinators, retroauricular, occipital and retropharyngeal nodes.
Adenopathy medial to carotid arteries above hyoid bone are referred to as
retropharyngeal nodes.
Criteria for deciding pathologic lymph nodes:

346

Neck Nodes

Level VII are adenopathy medial to the carotid arteries within the superior
mediastinum.