CERVICAL LYMPH NODES| Tutorial B-1 RS

130110110177|Gabriella Chafrina| 03/12/13

CLASSIFICATION:
1) Upper horizontal chain of nodes
a) Submental
- Lie on myolohyoid muscle in the submental triangle
- 2 to 8 in number
- Afferent chin, middle part of lower lip, anterior gums, anterior floor of mouth and tip of
tongue
- Efferent submandibular and internal jugular chain
b) Submandibular
- Lie on submandibular triangle in relation to submandibular gland in relation to submandibular
gland
- Afferent lateral part of the lower lip, upper lip, cheek, nasal vestibule and anterior part of
nasal cavity, gums teeth medial, soft palate, submandibular and sublingual salivary glands and
floor of mouth
- Efferent internal jugular chain
c) Parotid
- Lie in relation to the parotid salivary gland
- Afferent scalp, pinna, external auditory canal, face buccal mucosa
- Efferent internal jugular or external jugular chain
d) Postauricular (mastoid nodes)
- Lie behind the pinna and over the mastoid
- Afferent the scalp, posterior surface of pinna and skin of mastoid
- Efferent internal jugular chain
e) Occipital
- Lie at the apex of the posterior triangle
- Afferent scalp, skin of upper neck
- Efferent upper accessory chain of nodes

2) Lateral cervical nodes
a) Superficial external jugular group
- Lie along external jugular vein and drains into internal jugular and transverse cervical nodes
b) Deep group
i. Internal jugular chair
- Lymph nodes of internal jugular chain lie anterior, lateral, and posterior to internal jugular
vein
Upper group (jugulodigastric node) oral cavity, oropharynx, nasopharynx,
hypopharynx, larynx and parotid
Middle group hypopharynx, larynx, thyroid, oral cavity, oropharynx
Lower group larynx, thyroid and cervical oesophagus
ii. Spinal accessory chain
- Lies along the spinal accessory nerve
- Afferent scalp, skin of neck, nasopharynx, occipital and postauricular nodes
- Efferent transverse cervical chain
iii. Transverse cervical chain (supraclavicular nodes)
- Lies horizontally, along the transverse cervical vessels, in the lower part of posterior triangle
- Medial nodes of the group called scalene nodes
- Afferent accessory chain and infraclavicular structures (i.e: breast, lung, stomach, colon,
ovary, and testis)
CERVICAL LYMPH NODES| Tutorial B-1 RS

130110110177|Gabriella Chafrina| 03/12/13
3) Anterior cervical nodes
- Lie between the 2 carotids and below the level of hyoid bone and consists of 2 chains:
a) Anterior jugular chain
- Lies along anterior jugular vein and drains the skin of anterior neck
b) Juxtavisceral chain
Prelaryngeal node (Delphian node)
- Lies on cricothyroid membrane
- Afferent subglottic region of larynx and pyriform sinuses
Pretracheal node
- Lie in front of the trachea, and drain thyroid gland and the trachea
- Efferent paratracheal, lower internal jugular and anterior mediastinal nodes
Paratracheal node
- Afferent thyroid lobes, subglottic larynx, trachea and cervical oesophagus

CLASSIFICATION OF NECK NODES ACCORDING TO LEVELS:
Level I: Submental and Submandibular nodes
o Submental nodes:
- Lie in the submental triangle, ex: between right and left anterior bellies of digastric muscles and
hyoid bone
o Submandibular nodes:
- Lie between anterior and posterior bellies of digastric muscle and the body of mandible
Level II: Upper jugular nodes
- Located along the upper third of jugular vein, ex: between the skull base above, and the level of
hyoid bone (or bifurcation of carotid artery) below
Level III: Middle jugular nodes
- Located along the middle third of jugular vein, from the level of hyoid bone above, to the level of
upper border of cricoid cartilage
Level IV: Lower jugular nodes
- Located along the lower third of jugular vein, from upper border of cricoids cartilage to the clavicle
Level V: Posterior triangle group
- Located in the posterior triangle, ex: between posterior border of sternocleidomastoid (anteriorly),
anterior border of trapezius (posteriorly), and the clavicle below
- Include lymph nodes of spinal accessory chain, transverse cervical nodes and supraclavicular nodes
Level VI: Anterior triangle group
- Located between the medial borders of the sternocleidomastoid muscles (or carotid sheaths) on
each side, hyoid bone above and suprasternal notch below
- Include prelaryngeal, pretracheal, paratracheal nodes
Level VII: Upper mediastinum nodes
- Located below the suprasternal notch








CERVICAL LYMPH NODES| Tutorial B-1 RS

130110110177|Gabriella Chafrina| 03/12/13
EXAMINATION OF NECK NODES:
- Neck nodes are better palpated while standing at the back of the patient. Neck is slightly flexed to
achieve relaxation of muscles
- When a node or nodes are palpable, look for the following points:
o Location of nodes
o Number of nodes
o Size abnormal nodes
Greater than 1.5 cm in jugulodigastric area (level I, II, III)
Greater than 1 cm elsewhere
o Consistency
Metastatic nodes are hard
Lymphoma nodes are firm and rubbery
Hyperplastic nodes are soft
Metastatic melanoma nodes are soft
o Discrete or matted nodes
o Tenderness
Inflammatory nodes are tender
o Fixity to overlying skin or deeper structures. Mobility should be checked both in the vertical and
horizontal planes
- The nodes examined in following manner: (so none missed)
o Upper horizontal chain
Submental
Submandibular
Roll your fingers against inner surface of Mandible with patients head gently tilt towards 1 side
Parotid (Preauricular) nodes
Roll of your finger in front of the ear, against the maxilla
Mastoid (Postauricular) nodes
Occipital nodes
o External jugular chain
- Lies superficial to sternomastoid
o Internal jugular chain
- Examine the upper, middle, lower groups
- Many of them lie deep to sternomastoid muscles which may need to be displaced posteriorly
o Spinal accessory chain
o Transverse cervical chain
Supraclavicular (scalene nodes)
Roll your finger gently behind the clavicles. Instruct the patient to cough or to bear down like
they are having a bowel movement. Occasionally an enlarged lymph may be pop up
o Anterior jugular chain
o Juxtavisceral chain








CERVICAL LYMPH NODES| Tutorial B-1 RS

130110110177|Gabriella Chafrina| 03/12/13




SUBMENTAL NODES SUBMANDIBULAR NODES













MASTOID NODES OCCIPITAL NODES


PAROTID NODES







SCALENE NODES
EXTERNAL & INTERNAL JUGULAR CHAIN



CERVICAL LYMPH NODES| Tutorial B-1 RS

130110110177|Gabriella Chafrina| 03/12/13

UPPER HORIZONTAL CHAIN OF NODES LATERAL CERVICAL NODES






















ANTERIOR CERVICAL NODES DRAINAGE OF DEEP GROUP NODES

CERVICAL LYMPH NODES| Tutorial B-1 RS

130110110177|Gabriella Chafrina| 03/12/13

SPINAL ACCESSORY CHAIN SUPRACLAVICULAR NODES ANTERIOR CERVICAL GROUP




















CERVICAL LYMPH NODE LEVEL