Area I contains the submental lymph nodes and the submaxillary lymph nodes.
The ii zone consists of the anterior cervical lymph node and the internal jugular vein lymph chain from the base of the skull to the level of the hyoid bone (superior internal jugular lymph node, above the level of the hyoid bone to the base of the skull).
The zone iii consists of the internal jugular vein lymph node chain from the hyoid bone to the cricoid cartilage (middle internal jugular vein lymph node, between the level of the hyoid bone and the level of the cricoid cartilage).
Iv area of the ring cartilage and clavicle between the internal jugular vein lymph node chain (inferior internal jugular vein lymph node, cricoid cartilage level below and between the clavicle).
The lymph node in this site follows the spinal accessory nerve chain behind the sternocleidomastoid (accessory nerve lymph node).
Region refers to the lymph node (anterior cervical lymph node) bounded by the carotid sheath from the hyoid bone to the suprasternal notch.
The lymph node in the vii region lies in the upper mediastinum (upper mediastinal lymph node).
The first zone (level 1)
Including submental and submaxillary lymph nodes. There are approximately 1-14 lymph nodes, containing lymph fluid from the chin, lips, buccal, base of mouth, anterior tongue, palate, sublingual and submandibular glands.
I area with the digastric muscle as the boundary divided into two parts, inside the lower part for I a area, outside the upper part for I b area.
Zone (level 2)
It is the superior region of the internal jugular vein lymph node, namely, below the digastric muscle, which corresponds to the level of the skull base to the hyoid bone, with the lateral border of the sternohyoid muscle in the anterior border and the posterior border of the sternocleidomastoid muscle in the posterior border. The lymph node in this region is often the first site of metastasis of laryngeal cancer, which has important reference value in clinic.
The ii region is divided into two parts by the accessory nerve, the anterior lower part is the ii a region, the posterior upper part is the ii b region.
It is the middle region of the internal jugular vein lymph node, from the level of hyoid bone to the intersection of omohyoid muscle and internal jugular vein, and the anterior and posterior boundaries are the same as the ii area.
Iv area (level iv)
This is the inferior region of the internal jugular vein lymph node. From the omohyoid to the supraclavicular. The anterior and posterior boundaries, as well as the ii zone, lie within the lateral margins of the omohyoid, clavicle, and sternocleidomastoid.
Iv area ii, iii and iv area jointly constitute the internal jugular vein lymph chain, which contains lymph fluid from parotid gland, subjaw, subchin, posterior pharyngeal wall and anterior cervical lymph nodes, so it is the key area in neck dissection.
V area (level 5)
These include the posterior occipital triangle lymph nodes or accessory nerve lymph chains and supraclavicular lymph nodes. The posterior border is the anterior border of the trapezius, the anterior border of the sternocleidomastoid, and the lower border is the clavicle.
The v region is bounded by the lower belly of the omohyoid muscle, with a v a region above and a v b region below. The supraclavicular lymph node belongs to the v b region.
Region v is a high-risk area for metastasis of nasopharyngeal, oropharyngeal, subglottic, piriform fossa, cervical esophagus and thyroid tumors.
6 area (level 6)
For internal surrounding lymph nodes (juxta visceral nodes), or the area before the said (anterior compartment). About 6 ~ 16 lymph nodes, including circumthyroid lymph nodes, lymph nodes around the trachea (recurrent laryngeal nerve), and lymph nodes around the thyroid gland, are included. This area is bounded by the common carotid artery and the internal jugular vein. The upper boundary is the hyoid bone and the lower boundary is the superior sternal fossa. Among them, the anterior laryngeal lymph node is located in the cricothyroid membrane and receives lymphatic fluid in the subglottic area, which is of great clinical significance.
The vi area is the high-risk area for occult metastasis of thyroid gland, glottis and inferior larynx, piriform fossa roof and cervical esophageal tumors.
6 area (level 6)
When the American joint committee on cancer (ajcc) published TNM staging, it added the 7th division, namely, the upper mediastinal lymph node, bounded by the common carotid artery on both sides, the upper sternal superior socket, and the lower border by the level of arterial arch.
The xvii area is closely related to the metastasis of thyroid cancer, hypopharyngeal cancer and cervical esophageal cancer.
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