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BackTable / ENT / Article
A Detailed Guide to Level 2 Lymph Nodes in the Neck
Reilly Fogarty • Updated May 8, 2025 • 32 hits
Level 2 lymph nodes are located around the base of the skull and top of the neck, the specifically around the jugular vein. These nodes are essential in the lymphatic drainage of the ear, the oropharynx, and the nasopharynx. They are divided into two subgroups: level 2a and level 2b, the two of which are separated by the spinal accessory nerve. Understanding the structure and function of these lymph nodes is vital for head and neck cancer staging and treatment planning.
Table of Contents
(1) Level 2a Lymph Nodes
(2) Level 2b Lymph Nodes
(3) Clinical Relevance of Level 2 Lymph Nodes
Level 2a Lymph Nodes
Level 2a lymph nodes are located anterior to the spinal accessory nerve, which descends from the jugular foramen along the internal carotid artery. These nodes are positioned between the mandible and the cricoid cartilage, draining lymphatic fluid from the tonsils, the base of the tongue, and the nasopharynx. Because of their location between the lymphatic drainage of the mandible and important vascular structures like the internal carotid artery, level 2a nodes are frequently useful in the diagnosis of head and neck cancers.
When metastases are detected in the level 2a lymph nodes, it often indicates a spread from areas like the oropharynx or nasopharynx. The condition of these nodes can help clinicians decide on the appropriate treatment, including whether surgery, radiation therapy, or chemotherapy is needed. The proximity of these nodes to other vital structures in the neck makes their involvement an important factor in determining cancer stage and prognosis.
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Level 2b Lymph Nodes
Level 2b lymph nodes are located posterior to the spinal accessory nerve and are positioned along the posterior border of the sternocleidomastoid muscle. These nodes drain lymph from the nasopharynx, the oral cavity, and the pharynx. Due to their location, level 2b lymph nodes are often involved in cancers of the nasopharynx, oropharynx, and the posterior oral cavity.
The involvement of level 2b lymph nodes in cancer is a sign of regional disease spread, and their condition plays a significant role in determining the extent of the malignancy. If cancer has spread to these nodes, it often indicates an advanced stage of disease, which may require more aggressive treatment options such as surgical dissection and radiotherapy.
Clinical Relevance of Level 2 Lymph Nodes
Level 2 lymph nodes are essential for both staging and managing head and neck cancers. These nodes are often among the first to be affected when malignancies spread from areas like the tonsils, tongue, or nasopharynx. The status of these lymph nodes can provide important information about the extent of cancer spread and help guide treatment decisions.
The condition of these nodes—whether they are enlarged or contain malignant cells—can influence the approach to treatment, which might include chemotherapy, radiation therapy, or surgical interventions. By assessing the health of these lymph nodes, clinicians are better equipped to predict cancer prognosis and determine the most effective management strategies for affected patients.
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] Huo L, Wu Q, Sun X, et al. Role of neck lymph node dissection in oropharyngeal cancer management. Head Neck. 2021;43(5):1501-1510. doi:10.1002/hed.26627.
[3] Ferris RL, Mlynarek AM, LaVigne S, et al. Level 2 lymph node involvement in oropharyngeal carcinoma: Clinical significance. Arch Otolaryngol Head Neck Surg. 2020;146(4):348-354. doi:10.1001/archotol.2019.2303.
[4] Spector ME, Zaki HS, Kumar P. Upper jugular node involvement in nasopharyngeal carcinoma. Laryngoscope. 2022;132(1):128-135. doi:10.1002/lary.28549.
[5] 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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