The major lymph node drainage is into the jugular chain of nodes. The deep cervical node and posterior triangle nodes are also readily related to the hypopharynx. The vagus nerve (cranial nerve X) plays an important role in sensation and muscular innervation of the hypopharynx and larynx. Note that only the vagus nerve is left in the lower neck as the other cranial nerves terminate in the head with the exception of the spinal accessory XI nerve. The jugulo-omohyoid node is often the sentinel node for hypopharyngeal cancers. There is a high degree of lymph node involvement including the parapharyngeal and retropharyngeal nodes, as well as the jugulodigastric and jugulo-omohyoid nodes.