The anatomic designation of cervical nodes is indicated. The majority of head and neck cancers are squamous and spread sequentially along lymphatic pathways. As a result, good treatment results are obtained by appropriate surgical resection of tumor and regional nodal basins. Chemoradiation is also dramatically changing the need for extensive nodal dissection.
Current anatomical staging of head and neck tumors includes designation of nodal areas. Level I is submandibular, levels II-IV are internal jugular areas separated by the hyoid and omohyoid. Level V is posterior triangle bounded by sternocleidomastoid and trapezius. Level VI is anterior neck.
In 1906 George Crile devised the radical neck dissection, taking sternocleidomastoid, omohyoid, internal jugular vein and spinal accessory nerve along with associated lymphatic-bearing soft tissue. Boundaries are the body of the mandible above to clavicle below, and trapezius posteriorly to edge of straps anteriorly.