The head and neck contains a rich and elaborate lymphatic network of more than 300 nodes and their intermediate channels. Aponeuroses bind them together with the muscles, nerves, and vessels of the head and neck. These lymphatic chains are strongly lateralized and typically do not directly communicate between left and right in the absence of a pathologic process. This lymphatic drainage originates at the base of the skull, then proceeds to the jugular chain adjacent to the internal jugular vein. From there it moves into the spinal accessory chain adjacent to the spinal accessory nerve, or cranial nerve XI, and then meets the supraclavicular chain. The lymphatics then drain on both sides. On the left side, they drain either directly into the vasculature via the jugulo-subclavian venous confluence or directly into the thoracic duct. On the right side, they flow directly into the lymphatic duct. Conversely, most structures drain ipsilaterally, except in the case of structures situated at the anatomic midlines. These include the nasopharynx, pharyngeal wall, base of the tongue, soft palate, and larynx. The lymph nodes of the neck are further classified by level. These levels are Ia, Ib, II, III, IV, V, VI, VII, VIII, IX, X. [1][2][3][4][5] Show Level Ia: Submental Group
Level Ib: Submandibular Group
Level II: Upper Jugular Group
Level III: Middle Jugular Group
Level IVa: Lower Jugular Group
Level IVb: Medial Supraclavicular Group
Level Va and Vb: Posterior Triangle Group
Level Vc: Lateral Supraclavicular Group
Level VI: Anterior Compartment Group The anterior compartment contains this nodal group, which is symmetric about the anatomic midline. It is also further subdivided into the superficially-located anterior jugular nodes, or level VIa, and the deeper pre-laryngeal, pre-tracheal, and para-tracheal (recurrent laryngeal) nodes, or level VIb. Level VIa
Level VIb
Level VII: Prevertebral Compartment Group, including Levels VIIa and VIIbLevel VIIa: Retropharyngeal Nodes
Level VIIb: Retrostyloid Nodes
Level VIII: Parotid Group
Level IX: Buccofacial group
Level X: Posterior Skull Group, including Levels Xa and Xb Level Xa: Retroauricular and Subauricular Nodes
Level Xb: Occipital Nodes
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