Anatomy · Plate VI

The lymph node levels of the neck

Level IUnder the chin and under the jaw.
Level IIThe upper neck along the jugular vein, from the base of the skull to the hyoid bone.
Level IIIThe middle neck along the jugular vein, from the hyoid bone to the cricoid cartilage.
Level IVThe lower neck along the jugular vein, down to the collarbone.
Level VThe back of the neck, behind the large muscle that turns the head (sternocleidomastoid).
Level VIThe front of the neck, around the windpipe and the thyroid.

Simplified drawing, not to scale.

The neck contains the lymph nodes into which cancers of the head and neck drain, the great vessels to the brain, the nerves to the shoulder and tongue, and the muscles that turn the head. A lump in the neck therefore needs a clear diagnosis, and treatment of the lymph nodes is part of the treatment of most head and neck cancers.

What it is

A neck dissection is an operation that removes lymph nodes from the neck in groups (levels I to VI), so that cancer cells that have spread to them, or may have spread, are removed and examined. It is done together with the removal of the primary tumour or as a separate operation, for example after radiotherapy. Surgery for a neck mass is the removal of a lump for diagnosis or treatment: a cyst, a benign tumour, an enlarged lymph node, or a growth of the thyroid or salivary glands.

Who it is for

Adults with a head and neck cancer whose lymph nodes are involved or at risk; adults with a lymph node that contains cancer from a primary site that has not yet been found; and adults with a persistent neck lump for which a diagnosis is needed.

Symptoms and diagnosis

A lump in the neck may be felt by the patient or found on an examination or scan. Its position, size, consistency and how long it has been there all point towards its cause. Ultrasound is the first investigation, usually combined with a fine-needle biopsy of the lump. CT, MRI or PET scanning shows the extent and looks for a primary tumour when the lump is a lymph node containing cancer. Examination of the mouth, throat and larynx with an endoscope is part of the assessment in adults.

How the operation is done

Under general anaesthesia, the neck is opened through an incision placed in a skin crease. The lymph nodes are removed together with the surrounding fatty tissue, level by level, while the carotid artery, the jugular vein, the nerve to the shoulder muscle (accessory nerve) and the other nerves of the neck are identified and preserved whenever the cancer allows. For a single neck mass the incision is placed over the lump, and the mass is removed intact for examination. Small drains are left in place for a few days. The pathology report of the nodes guides whether radiotherapy or other treatment is needed afterwards.

Recovery

The hospital stay is a few days for a neck dissection and shorter for the removal of a single mass. The neck is stiff and numb at first; movement exercises and, when needed, physiotherapy for the shoulder start early. Sensation in the skin returns slowly. The scar lies in a crease and fades over months. Follow-up visits continue at intervals set by the diagnosis.

How Prof. Hafız works

Neck surgery is among the focus areas of Prof. Hafız’s practice, and his published research includes work on lymph node metastases in head and neck cancer and on the accessory nerve and quality of life after treatment for laryngeal cancer. The extent of the dissection, what will be preserved and the likely effect on the shoulder and neck are explained before the operation.

References

Clinical Practice Guideline: Evaluation of the Neck Mass in Adults, Otolaryngology–Head and Neck Surgery (2017) — doi:10.1177/0194599817722550
Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery, Archives of Otolaryngology–Head & Neck Surgery (2002) — doi:10.1001/archotol.128.7.751
Consensus Statement on the Classification and Terminology of Neck Dissection, Archives of Otolaryngology–Head & Neck Surgery (2008) — doi:10.1001/archotol.134.5.536
Metastatic Squamous Neck Cancer with Occult Primary Treatment (PDQ®)⁠–⁠Patient Version, National Cancer Institute (2025) — cancer.gov · Accessed 2026-10-08
Suspected cancer: recognition and referral (NG12), National Institute for Health and Care Excellence (2015) — nice.org.uk · Accessed 2026-10-09
Symptoms of laryngeal cancer, NHS — nhs.uk · Accessed 2026-10-09

What to expect

Before

Ultrasound, usually with a fine-needle biopsy of the lump.
CT, MRI or PET, and an examination of the mouth, throat and larynx with an endoscope.

On the day

General anaesthesia and an incision in a skin crease of the neck.
The nodes are removed level by level, while the vessels and nerves are preserved whenever the cancer allows.

After

A few days in hospital after a neck dissection, often less after removal of a single lump.
Movement exercises, and physiotherapy for the shoulder when needed, start early.
Feeling in the skin returns slowly; the scar fades over months.

Questions patients ask

Is a lump in the neck always serious?

No. Many neck lumps are enlarged lymph nodes from an infection, cysts or benign tumours. A lump that lasts for more than a few weeks, grows, or is hard and does not hurt should be examined, particularly in adults.

What is the difference between a selective and a comprehensive neck dissection?

A selective neck dissection removes the groups (levels) of lymph nodes most likely to be involved and spares the others, together with the muscle, vein and nerve of the neck. A comprehensive dissection removes more levels and, when the cancer involves them, some of those structures as well.

Will my shoulder be affected?

The nerve to the shoulder muscle runs through the area. It is preserved whenever the cancer allows, and physiotherapy helps shoulder movement recover afterwards.

Neck dissection and neck masses