- Closer the cancer to midline, greater risk of bilateral nodes
- Previous surgery or radiotherapy may result in unusual nodal disease
- Midline nodes are considered ispilateral
Oral cavity:
- Nodal spread depends upon T staging. M spread is depends on N staging
- Midline nodes are considered ipsilateral
- Usually follow L2 to L4
- Cancers of hard palate and alveolar ridges commonly spread to L1, L2, buccinator, and rarely L5 or supraclavicular
- Cancers of anterior oral cavity may directly spread to L3
- Oral tongue cancer may directly spread to L4
Nasopharynx:
- Commonly spread to retropharyngeal, upper jugular and spinal accessory nodes
- Often bilateral spread
Oropharynx:
- Level II and III, less commonly level I nodes
Hypopharynx:
- Parapharyngeal, paratracheal and level III and IV nodes
Supraglottis:
- Rich bilaterally connected lymphatics, hence nodal disease is common
- Commonly spread to Level II and III, less common to level I
Glottis:
- Nearly devoid of any lymphatics, hence rarely spread to regional nodes
Subglottis:
- Prelaryngeal, pretracheal, paralaryngeal, paratracheal nodes
