Corpus: Cervical lymph nodes
1. Definition
The cervical lymph nodes are the lymph nodes located in the neck area.
2. Classification
There are more than 300 cervicofacial lymph nodes, which vary in number, distribution, and location. Their classification is not consistent across anatomical literature. In addition to anatomical classifications, various clinical nomenclatures exist, particularly in oncology and surgery.
2.1. ...anatomical
Anatomically, cervical lymph nodes can be classified based on two aspects:
...according to their position in relation to the superficial leaf of the cervical fascia
- Superficial cervical lymph nodes (Nodi lymphatici cervicales superficiales)
- Deep cervical lymph nodes (Nodi lymphatici cervicales profundi)
...according to their location on the neck
- Anterior cervical lymph nodes (Nodi lymphatici cervicales anteriores) located in the front of the neck, below the hyoid bone
- Lateral cervical lymph nodes (Nodi lymphatici cervicales laterales) ifound in the lateral neck region, near the sternocleidomastoid muscle
- Retropharyngeal cervical lymph nodes (Nodi lymphatici retropharyngeales)
By combining these two aspects, the following classification emerges:
2.1.1. Superficial cervical lymph nodes
Superficial cervical lymph nodes are located in the lateral neck, along the external jugular vein on the surface of the sternocleidomastoid muscle. They connect to the deep cervical lymph nodes via lymphatic vessels.
2.1.2. Deep cervical lymph nodes
2.1.2.1. Anterior deep cervical lymph nodes
The anterior deep cervical lymph nodes (Nodi lymphatici cervicales anteriores profundi) include the following groups, all of which are named after their reference organ:
- Prelaryngeal lymph nodes (Nodi lymphatici praelaryngeales) – in front of the larynx
- Thyroid lymph nodes (Nodi lymphatici thyreoidei) – around the thyroid gland
- Pretracheal lymph nodes (Nodi lymphatici praetracheales) – in front of the trachea
- Paratracheal lymph nodes (Nodi lymphatici paratracheales) – beside the trachea
2.1.2.2. Lateral deep cervical lymph nodes
The lateral deep lymph nodes (Nodi lymphatici cervicales laterales profundi) include:
- Lateral jugular lymph nodes (Nodi lymphatici jugulares laterales)
- Anterior jugular lymph nodes (Nodi lymphatici jugulares anteriores) – both groups are positioned along the internal jugular vein
- Jugulodigastric lymph node (Nodus lymphaticus jugulodigastricus) – at the junction of the internal jugular vein and the digastric muscle
- Juguloomohyoid lymph node (Nodus lymphaticus juguloomohyoideus) – located at the internal jugular vein, above the intermediate tendon of the omohyoid muscle
- Supraclavicular lymph nodes (Nodi lymphatici supraclaviculares) – found above the clavicle
The juguloomohyoid and supraclavicular lymph nodes are sometimes referred to as the lower deep cervical lymph nodes (Nodi lymphatici cervicales inferiores profundi), as described in Gray.
The submental (Nodi lymphatici submentales) and submandibular lymph nodes (Nodi lymphatici submandibulares), located below the chin and along the lower jaw, are classified either as part of the head or neck, depending on the author.
2.2. ...clinical
The most widely used clinical classification of cervical lymph nodes was established by the American Academy of Otolaryngology. It divides the lymph nodes into six levels, according to Robbins:
| Level | Lymph nodes |
|---|---|
| Level I | Submental and submandibular lymph nodes |
| Level II | Upper deep jugular (craniojugular) lymph nodes: from the skull base to the carotid bifurcation |
| Level III | Middle deep jugular (mediojugular) lymph nodes: from the carotid bifurcation to the junction of the omohyoid muscle and internal jugular vein |
| Level IV | Lower deep jugular (caudojugular) lymph nodes: from the crossing of the omohyoid muscle with the internal jugular vein to the clavicle |
| Level V | Lymph nodes in the posterior triangle of the neck ("accessory group") |
| Level VI | Lymph node group in the anterior triangle of the neck: includes parapharyngeal, retropharyngeal, and pretracheal lymph nodes ("anterior compartment") |
The level I lymph nodes can be further subdivided into:
- Ia: submental lymph nodes and
- Ib: submandibular lymph nodes
3. Clinic
Cervical lymph node enlargement (lymphadenopathy) can occur in systemic diseases (e.g., infectious mononucleosis, Hodgkin’s lymphoma) as well as in localized infections or malignant tumors of the head and neck region. Therefore, lymph node assessment is an essential part of a complete physical examination.