3/4/2023 0 Comments Cervical lymph nodesThis level includes pretracheal, paratracheal, pre-cricoid (Delphian), and peri-thyroidal LNs (including LNs located along the recurrent laryngeal nerves ). Level VA LNs include the spinal accessory LNs, while VB includes LNs located around the transverse cervical vessels and the supraclavicular LNs. Level VA LNs and VB LNs are separated by an imaginary horizontal plane marking the lower border of the cricoid cartilage. Anteriorly, it is bounded by the posterior border of SCM, and the posterior boundary is formed by the anterior border of the trapezius muscle. The upper limit of this group is the convergence of the trapezius and SCM muscles, while the lower boundary is formed by the clavicle. Levels VA and VB: Posterior Triangle Group It should be noted that the “Virchow” LN belongs to this group. Anteriorly, this group is bounded by the lateral border of sternohyoid muscle and posteriorly bounded by the posterior border of SCM. These LNs extend from the lower border of the cricoid cartilage to the clavicle, and they are located around the lower third of the IJV. The jugulo-omohyoid LN belongs to this group. Again, the anterior boundary is represented by the lateral border of sternohyoid muscle, and the posterior boundary is the posterior border of the SCM. This level extends from the inferior border of the hyoid bone superiorly to the inferior border of the cricoid cartilage inferiorly and is located around the middle third of the IJV. Radiologically, level IB and level IIA LNs are separated by the vertical plane at the posterior aspect of the submandibular gland. Level IIA LNs lie anterior to the vertical plane of the spinal accessory nerve, while IIB LNs lie posterior to this plane. Posteriorly, it is bounded by the posterior border of the sternocleidomastoid (SCM) muscle. Anteriorly, it is bounded by the lateral border of the sternohyoid muscle and the stylohyoid muscle. They extend from the skull base superiorly to the level of the inferior border of the hyoid bone inferiorly. Those are the LNs surrounding the upper third of the internal jugular vein (IJV). It should be noted that the submandibular gland should be included in the removed specimen if the LNs within this level are excised. These LNs lie within the triangle bounded by the anterior and posterior bellies of digastric muscle inferiorly and the body of the mandible superiorly. These LNs lie within the triangle bounded by the anterior belly of the digastric muscles (both sides) and the hyoid bone inferiorly. Full size image 8.1.1 Delineation of the Levels of Cervical Lymph Nodes (Fig.
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