The lymphatic drainage of the neck is somewhat complex, clinically. A relatively simple “level” system of nodal enlargement has been designed that is extremely helpful in evaluating lymph node spread of primary head and neck tumors. Once the number of levels of nodes are determined, and the size of the lymph nodes, the best mode of treatment can be instituted. This may include surgery, radiotherapy, and chemotherapy. The lymph node level also enables a prognosis to be made. The levels are as follows (Fig. 8.199):