Corpus: Cervical lymph nodes
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1. Definition
The cervical lymph nodes are the lymph nodes located in the neck area.
2. Classification
The more than 300 cervicofacial lymph nodes are very varied in terms of their number, distribution and location and are not uniformly described in the anatomical literature. In addition to the anatomical classifications, there are numerous clinical nomenclatures based on criteria relevant to oncology and surgery.
2.1. ...anatomical
Anatomically, the cervical lymph nodes can be categorised according to two aspects:
...according to their position in relation to the superficial leaf of the cervical fascia in
- superficial cervical lymph nodes (Nodi lymphatici cervicales superficiales) and
- deep cervical lymph nodes (Nodi lymphatici cervicales profundi)
...according to their location on the neck into
- anterior cervical lymph nodes (Nodi lymphatici cervicales anteriores) in the front of the neck below the hyoid bone,
- lateral cervical lymph nodes (Nodi lymphatici cervicales laterales) in the lateral neck region and in the area of the sternocleidomastoid muscle and
- retropharyngeal cervical lymph nodes (Nodi lymphatici retropharyngeales)
Summarising both observations results in the following grid:
2.1.1. Superficial cervical lymph nodes
The superficial cervical lymph nodes (Nodi lymphatici cervicales superficiales) are located in the lateral neck area in the course of the external jugular vein on the sternocleidomastoid muscle. They are connected 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:
- Nodi lymphatici praelaryngeales in the anterior region of the larynx
- Nodi lymphatici thyreoidei around the thyroid gland
- Nodi lymphatici praetracheales in front of the trachea (windpipe)
- Nodi lymphatici paratracheales next to the trachea
2.1.2.2. Lateral deep cervical lymph nodes
The lateral deep lymph nodes (Nodi lymphatici cervicales laterales profundi) include:
- Nodi lymphatici jugulares laterales
- Nodi lymphatici jugulares anteriores, each orientated on the internal jugular vein
- Nodus lymphaticus jugulodigastricus at the junction of the internal jugular vein and the digastric muscle
- Nodus lymphaticus juguloomohyoideus at the internal jugular vein above the intermediate tendon of the omohyoideus muscle
- Nodi lymphatici supraclaviculares above the clavicle
The last two groups of lymph nodes are also referred to (e.g. by Gray) as lower deep cervical lymph nodes (Nodi lymphatici cervicales inferiores profundi).
The nodi lymphatici submentales and the nodi lymphatici submandibulares located below the chin or on the lower jaw are assigned to the head by some authors and to the neck by others.
2.2. ...clinical
The most commonly used clinical classification of the cervical lymph nodes was developed by the American Academy of Otolaryngology and is based on a subdivision of the cervical 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: Cranial base to carotid bifurcation |
| Level III | Middle deep jugular (mediojugular) lymph nodes: Carotid bifurcation to junction of omohyoid muscle with internal jugular vein |
| Level IV | Lower deep jugular (caudojugular) lymph nodes: Crossing of the omohyoid muscle with the internal jugular vein to the clavicle |
| Level V | Lymph node group in the lateral neck triangle "Accessorius group" |
| Level VI | Lymph node group in the anterior triangle of the neck: parapharyngeal, retropharyngeal and pretracheal, "anterior compartment" |
The level I lymph nodes can be further subdivided into
- Ia: submental lymph node group and
- Ib: submandibular lymph node group
3. Clinic
Lymphadenopathy of the cervical lymph nodes occurs both in systemic diseases (e.g. mononucleosis infectiosa, Hodgkin's disease) and in local inflammations or malignant tumours of the orofacial region. It is therefore an obligatory component of the whole-body examination.