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BackTable / ENT / Article
A Guide to Level 1 Lymph Nodes in the Neck
Reilly Fogarty • Updated May 8, 2025 • 33 hits
Level 1 lymph nodes in the neck are key components of the lymphatic system that filter lymphatic fluid from various areas of the head and neck. These nodes are located just below the mandible and consist of the submental and submandibular lymph nodes, which drain lymph from areas such as the oral cavity, floor of the mouth, and lower lip. Understanding the anatomy, function, and clinical relevance of level 1 lymph nodes is integral to the diagnosis and management of head and neck cancers.
Table of Contents
(1) Level 1A: Submental Lymph Nodes
(2) Level 1B: Submandibular Lymph Nodes
(3) Clinical Relevance of Level 1 Lymph Nodes
Level 1A: Submental Lymph Nodes
The submental lymph nodes are positioned in the midline of the neck, just beneath the chin. They are responsible for draining lymph from the tip of the tongue, the floor of the mouth, and the lower lip. Due to their location and the areas they drain, these nodes are often the first to be involved in the spread of malignancies from the oral cavity. Cancers affecting the tongue or lip can lead to metastases in the submental lymph nodes, making them important in staging and treatment planning.
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Level 1B: Submandibular Lymph Nodes
Level 1B lymph nodes are located along the underside of the mandible, near the submandibular gland. These nodes drain lymph from the floor of the mouth, the anterior tongue, the gums, and parts of the upper throat. Like the submental nodes, submandibular lymph nodes are often involved in the metastatic spread of cancers originating from the oral cavity, oropharynx, and surrounding structures. Their involvement can be an important indicator of cancer progression and can influence treatment decisions such as surgery and radiation therapy.
Clinical Relevance of Level 1 Lymph Nodes
The submental and submandibular lymph nodes are often the first sites of metastasis for cancers originating from the oral cavity, floor of the mouth, and lips – making them particularly valuable for early diagnosis of head and neck cancers. When evaluating a patient for head and neck malignancies, clinicians pay particularly close attention to the status of level 1 lymph nodes, as their involvement can indicate more advanced disease and influence treatment strategies.
Metastases reaching the submental or submandibular nodes, for example, may prompt a more aggressive treatment approach, such as surgical dissection, radiation therapy, or chemotherapy. These nodes are also examined during routine surgical procedures for head and neck cancers, as a way to quickly assess for signs of cancer progression or spread.
Additional resources:
[1] O'Reilly M, McDonald P, Johnson A, et al. Lymph node levels in the neck and their significance in head and neck cancer. J Clin Oncol. 2020;38(19):2204-2211. doi:10.1200/JCO.20.01114.
[2] Shin DM, Pruitt S, Lippman SM. Neck lymph node involvement and its relationship to cancer prognosis. Cancer J. 2019;25(4):229-236. doi:10.1097/PPO.0000000000000387.
[3] Kim H, Lee A, Ryu H, et al. Role of lymph node dissection in the management of oral cavity cancers: A review. Oral Oncol. 2021;67:48-55. doi:10.1016/j.oraloncology.2021.03.003.
Podcast Contributors
Dr. Bharat Panuganti
Dr. Bharat Panuganit is an otolaryngologist and airway surgeon at Washington University in St. Louis, Missouri.
Dr. Gopi Shah
Dr. Gopi Shah is a pediatric otolaryngologist and the co-host of BackTable ENT.
Dr. Ashley Agan
Dr. Ashley Agan is an otolaryngologist in Dallas, TX.
Cite This Podcast
BackTable, LLC (Producer). (2024, November 12). Ep. 199 – Advances in Early Glottic Cancer Treatment Options [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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