Levels of a Neck Dissection

Level

Term

Boundaries

IA

submental

hyoid bone and the anterior belly of the digastric muscles

IB

submandibular

anterior belly of the digastric muscle, the stylohyoid muscle, body of the mandible

IIA

upper jugular

anterior to a vertical plane through the spinal accessory nerve, skull base, inferior border of hyoid bone, stylohyoid muscle

IIB

upper jugular

posterior to a vertical plane through the spinal accessory nerve, skull base, inferior border of hyoid bone, posterior border of the sternocleidomastoid muscle

III

middle jugular

inferior border of hyoid bone, inferior border of the cricoid cartilage, lateral border of the sternohyoid bone, posterior border of sternocleidomastoid muscle

IV

lower jugular

inferior border of cricoid cartilage to clavicle, lateral border of the sternohyoid muscle, posterior porder of the sternocleidomastoid muscle

VA

posterior triangle

convergence of the sternocleidomastoid and trapezoid muscles, above a horizontal line plane through the inferior border of the anterior cricoid arch, , posterior border of the sternocleiomastoid muscle, anterior border of the trapezius muscle

VB

posterior triangle

below a horizontal line plane through the inferior border of the anterior cricoid arch, clavicle, posterior border of the sternocleiomastoid muscle, anterior border of the trapezius muscle

VI

anterior, paratracheal

hyoid bone, suprasternal notch, left and right common carotid arteries

Level

Lymph nodes include

IA

IB

prevascular and postvascular nerves (facial artery)

IIA

jugulodigastric (principle node of Kuttner)

IIB

III

omohyoid node

IV

Virchow’s node

VA

nodes along the spinal accessory nerve

VB

transverse cervical nodes, supraclavicular nodes

VI

paratracheal, pretracheal, precricoid (Delphian), perithyroid, nodes along the recurrent laryngeal nerve

Level

Positive in Cancers of

IA

floor of mouth, anterior tongue, lower lip, anterior mandibular alveolar ridge, skin of lower face

IB

oral cavity, anterior nasal cavity, submandibular gland, midface

IIA or IIB

tonsil, tongue base, parotid, nasopharynx, oropharynx, hypopharynx, middle ear, hard and soft palate

III

hypopharynx, larynx, thyroid, oral cavity, nasopharynx, tongue base, tonsils

IV

hypopharynx, larynx, thyroid, cervical esophagus, retropharyngeal, pretracheal, non-head and neck

VA or VB

nasopharynx, orphyarynx, tongue base, tonsils, malignant lymphoma, skin of posterior scalp or upper posterior neck

VI

thyroid, larynx (glottic, subglottic), cervical esophagus, apex of piriform sinus