What is ENT - Where do the lymphatic levels of the neck begin and end?
The borders of lymph node levels can be determined physically during surgical dissection or by using radiographic correlates. Different radiological and surgical landmarks are used to identify specific neck level limits. In brackets, the radiographic landmarks are listed: Level I Level Ia – Submental • Superior: Mandible • Inferior: Hyoid bone • Lateral: Ipsilateral anterior belly of the digastric muscle • Medial: Midline of the neck from the mandible to the hyoid Level Ib – Submandibular • Superior: Mandible • Inferior: Digastric attachment to hyoid (inferior edge of hyoid) • Lateral/posterior: Posterior belly of the digastric muscle • Medial: Anterior belly of the digastric muscle Level II Level IIa – Upper Jugular Region • Superior: Skull base • Inferior: Carotid bifurcation (hyoid bone) • Lateral/posterior: Spinal accessory nerve (posterior border of internal jugular vein) • Medial: Lateral border of the sternohyoid and stylohyoid muscles Level IIb – Submuscular recess • Superior: Skull base • Inferior: Carotid bifurcation (hyoid bone) • Lateral/posterior: Lateral border of the SCM • Medial: Spinal accessory nerve (medial border of internal carotid artery) Level III – Mid-Jugular • Superior: Carotid bifurcation (hyoid bone) • Inferior: Omohyoid muscle (inferior border of cricoid cartilage) • Lateral/posterior: Sensory branches of cervical plexus (lateral border of the SCM) • Medial: Lateral border of the sternohyoid muscle (medial border of common carotid artery) Level IV – Lower Jugular • Superior: Omohyoid muscle (inferior border of cricoid cartilage) • Inferior: Clavicle • Lateral/posterior: Sensory branches of cervical plexus (lateral border of the SCM) • Medial: Lateral border of the sternohyoid muscle (medial border of common carotid artery) Level V – Posterior Triangle Level Va • Superior: Convergence of SCM and trapezius muscles • Inferior: Inferior border of cricoid cartilage • Lateral: Anterior border of the trapezius muscle • Medial: Sensory branches of cervical plexus (lateral border of the SCM) Level Vb • Superior: Inferior border of cricoid cartilage • Inferior: Clavicle • Lateral: Anterior border of the trapezius muscle • Medial: Sensory branches of cervical plexus (lateral border of the SCM) Level VI – Anterior Compartment • Superior: Hyoid • Inferior: Suprasternal notch • Lateral: Common carotid arteries Level VII – Superior Mediastinal • Superior: Superior border of the sternum • Inferior: Innominate artery • Lateral: Innominate artery and left common carotid artery
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