Expansion
Submental to supraclavicular, level one to level six
Mnemonic
Six levels, running down and back:
- I - submental (Ia) and submandibular (Ib)
- II - upper jugular, above the hyoid
- III - middle jugular, hyoid to cricoid
- IV - lower jugular, below the cricoid
- V - posterior triangle
- VI - central compartment, from hyoid to sternal notch
“Levels II, III and IV run down the internal jugular vein; V is behind sternocleidomastoid; VI is in front of the trachea.”
Drainage predicts the primary: level I from the oral cavity and lip, II and III from the oropharynx and larynx, VI from the thyroid, and supraclavicular (level IV and V) from the chest and abdomen, which is the basis of Virchow’s node on the left signalling gastric malignancy.
Expansion
- Level I - submental and submandibular
- Level II to IV - upper, middle and lower jugular chain
- Level V - posterior triangle
- Level VI - central compartment