0:01

Hello everyone, it's Dr. Sidney Levy.

0:02

3 00:00:04,090 --> 00:00:07,800 Today I would like to discuss Level 5, or the

0:07

posterior triangle or spinal accessory lymph

0:11

nodes of the lymph node levels of the neck.

0:15

Level 5 has two sublevels, Level 5A and Level

0:18

5B, and I would like to show you the boundaries

0:21

and landmarks in order to quickly identify these

0:25

levels when staging a head and neck malignancy.

0:28

Let us begin with Level 5A.

0:30

I have some pre-contrast,

0:34

T1-weighted imaging in axial and

0:36

sagittal projections to assist us.

0:40

The boundaries that you need to be aware of are

0:43

the posterior border of sternocleidomastoid and the

0:47

anterior border of trapezius in the first instance.

0:52

Let me show you then, sternocleidomastoid,

0:57

trapezius, and there's one other structure

1:00

that's helpful to know as well, and

1:03

that's the scalenus anterior, just here.

1:08

These are the three muscles.

1:11

Level 5A is posterolateral to levels 2 and 3.

1:21

So it covers this region here, the posterior triangle.

1:28

Now, in a sagittal projection, I'll

1:30

show you once again those landmarks.

1:33

This is the trapezius, this is the sternocleidomastoid.

1:38

We're interested in the anterior

1:40

margin of the trapezius.

1:42

And the posterior margin of the sternocleidomastoid.

1:48

Now the only other thing you need to know

1:50

is what separates Level 5A and Level 5B.

1:54

It's just one structure.

1:56

It's the inferior margin of the cricoid cartilage.

2:00

So I will take you out of that.

2:03

We will go to the midline where

2:04

we can find the cricoid cartilage.

2:07

This is the cricoid cartilage here.

2:11

And we are interested in the inferior margin of it.

2:16

If you remember that, and we go off to the side, that

2:20

same landmark is applicable for Level 5A and Level 5B.

2:25

So therefore, if I draw the same plane laterally, and

2:31

then I redraw the anterior margin of trapezius and the

2:35

posterior margin of sternocleidomastoid, we have 5A.

2:41

And anything below the inferior margin of the

2:43

cricoid, down to the clavicle, is within 5B.

2:48

That's 5B.

2:50

That's all you need to remember.

2:52

And in our next vignette, we will cover Level 6.

Cervical Lymph Nodes Levels 5a & 5b

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0:01

Hello everyone, it's Dr. Sidney Levy.

0:02

3 00:00:04,090 --> 00:00:07,800 Today I would like to discuss Level 5, or the

0:07

posterior triangle or spinal accessory lymph

0:11

nodes of the lymph node levels of the neck.

0:15

Level 5 has two sublevels, Level 5A and Level

0:18

5B, and I would like to show you the boundaries

0:21

and landmarks in order to quickly identify these

0:25

levels when staging a head and neck malignancy.

0:28

Let us begin with Level 5A.

0:30

I have some pre-contrast,

0:34

T1-weighted imaging in axial and

0:36

sagittal projections to assist us.

0:40

The boundaries that you need to be aware of are

0:43

the posterior border of sternocleidomastoid and the

0:47

anterior border of trapezius in the first instance.

0:52

Let me show you then, sternocleidomastoid,

0:57

trapezius, and there's one other structure

1:00

that's helpful to know as well, and

1:03

that's the scalenus anterior, just here.

1:08

These are the three muscles.

1:11

Level 5A is posterolateral to levels 2 and 3.

1:21

So it covers this region here, the posterior triangle.

1:28

Now, in a sagittal projection, I'll

1:30

show you once again those landmarks.

1:33

This is the trapezius, this is the sternocleidomastoid.

1:38

We're interested in the anterior

1:40

margin of the trapezius.

1:42

And the posterior margin of the sternocleidomastoid.

1:48

Now the only other thing you need to know

1:50

is what separates Level 5A and Level 5B.

1:54

It's just one structure.

1:56

It's the inferior margin of the cricoid cartilage.

2:00

So I will take you out of that.

2:03

We will go to the midline where

2:04

we can find the cricoid cartilage.

2:07

This is the cricoid cartilage here.

2:11

And we are interested in the inferior margin of it.

2:16

If you remember that, and we go off to the side, that

2:20

same landmark is applicable for Level 5A and Level 5B.

2:25

So therefore, if I draw the same plane laterally, and

2:31

then I redraw the anterior margin of trapezius and the

2:35

posterior margin of sternocleidomastoid, we have 5A.

2:41

And anything below the inferior margin of the

2:43

cricoid, down to the clavicle, is within 5B.

2:48

That's 5B.

2:50

That's all you need to remember.

2:52

And in our next vignette, we will cover Level 6.

Report

Description

Faculty

Sidney Levy, PhD, MBBS

Radiologist and Nuclear Medicine Specialist

I-MED

Lesson

Oral Cavity Anatomy

Lesson

Oral Cavity Staging of Squamous Cell Malignancy

Lesson

Lymph Node Levels of the Neck

Lesson

Oropharynx

Lesson

Hypopharynx

Lesson

Larynx

Lesson

Sinonasal

Lesson

Perineural Tumor Spread

Cervical Lymph Nodes Levels 5a & 5b