The deep cervical lymph nodes form a long chain along the internal jugular vein, mostly hidden beneath the sternocleidomastoid, from the skull base to the root of the neck. All lymph from the head and neck eventually passes through them. Clinically they are divided into upper, middle and lower groups (levels II, III and IV), and nodes along the accessory nerve make up level V.
| Location | Along the internal jugular vein within the carotid sheath region, largely under the sternocleidomastoid, from the base of the skull to the root of the neck |
|---|---|
| Receives lymph from |
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| Lymphatic drainage |
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Act as the final filtering chain for all lymph from the head and neck before it returns to the venous system.
This chain is the main route of spread for head and neck cancers, and neck dissection removes it in levels. A hard, painless, persistent lump along the sternocleidomastoid in an adult, especially a smoker, should be presumed cancer until proven otherwise. Tuberculous lymphadenitis (scrofula) commonly involves this chain. Their efferents form the jugular lymphatic trunk.
Spread of mouth, throat, larynx or skin cancer to the deep cervical chain, the main determinant of neck staging.
TB infection of neck nodes causing matted, painless swellings that may discharge through the skin (scrofula).
Damage to the spinal accessory nerve while clearing level II and V nodes, causing shoulder droop and weakness.
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