Lymphatic drainage of the head and neck

• Tissue fluid is produced in excess by the arterial ends of the circulatory system

• The excess fluid, proteins, large particulate matters, and foreign substances find their way to the lymphatic vessels to the lymph nodes located along the course of the vessels.

• The fluid is filtered and foreign substances phagocytosed, and the node swell

• The position of the nodes denotes the general location of infection

Lymphatic drainage of head & neck

• Lymph nodes in the head and neck consist of a number of regional groups and terminal one.

• They consist of outlying nodes (circular) which all drain into the deep cervical group (vertical) .

• The outlying nodes are usually subcutaneous while others are deep and are named according to their position

Lymphatic drainage of head & neck

• Regional :– Submental nodes:

• Three to four in number, lie below the chin

• Some superficial other deep to the investing deep cervical fascia

• Drain a wedge of tissues in the floor of the mouth, lower incisor, gum and lip

• The drain into the submandibular group or directly into the deep cervical group

Lymphatic drainage of head & neck

• Submandibular nodes:– Half a dozen, lie on the surface

of the submandibular salivary gland or embedded within it.

– Drain the submental nodes, lateral part of the lower lip, upper lip and external nose, anterior 2/3 of the tongue.

– Anterior half of the nasal walls, paranasal sinuses and all the teeth except lower anterior.

Lymphatic drainage of head & neck

• Buccal node:– lies over the buccinator muscle

on the facial vein

– drain into the submandibular group

• Preauricular nodes:– lie within the parotid gland

– Drain the temporal part, lateral surface of auricle, anterior wall of external meatus, and lateral part of the eyelids

– Drain into deep cervical group

Lymphatic drainage of head & neck

• Posterior auricular nodes:– situated on the lateral of the

mastoid process – receive lymph from a scalp

above the auricle and the posterior border of the auditory meatus

• Occipital nodes:– situated at the apex of the

posterior triangle of the neck– receive lymph from the back of

the scalp

Lymphatic drainage of head & neck

• Anterior cervical nodes:– situated along the course of the

anterior jugular vein– receive lymph from the skin and

superficial tissues of the front of the neck.

• Superficial cervical nodes:– lie along the course of the external

jugular vein– receive lymph from skin over the

angle of the mandible and over the apex of the parotid gland and lobe of the ear

Lymphatic drainage of head & neck

• Retropharyngeal nodes:– lie in the retropharyngeal space, between the

pharyngeal wall and the prevertebral fascia– receive lymph from the nasal pat of pharynx,

auditory tube and upper cervical vertebrae

• Laryngeal nodes:– in front of the larynx

• Tracheal nodes:– lateral and infront of the trachea– receive from the thyroid gland

Lymphatic drainage of head & neck

• Deep cervical nodes:– scatter in the carotid sheath, in front

and behind the internal jugular vein along its course.

– They lie undercover of the sternocleidomastoid muscle.

– Divided into upper and lower groups and they are connected by lymphatic channels.

– Receive lymph from regional nodes

Lymphatic drainage of head & neck

• Upper group:– Receive lymph from the

posterior part of the tongue, tonsil, ear, nose, sinuses, upper part of pharynx and larynx.

– The Jugulo-digastric nodes lie just below the posterior belly of the digastric muscle, and is clinically palpable below angle of the mandible.

– Drain the back of the tongue

Lymphatic drainage of head & neck

• Lower group:– Receive lymph from anterior

part of the face, the scalp, anterior two third of the tongue, lower part of the pharynx and larynx and thyroid gland.

– The Jugulo-omohyoid nodes related to the intermediate tendon of the omohyoid muscle and is concerned with drainage of lymph from the anterior part of the tongue

Lymphatic drainage of head & neck

• Jugular lymph trunk:– Formed by joining of lymphatic

vessels at the lower end of the deep cervical lymph nodes.

– On the left side, it joins the internal jugular or the subclavian veins

– On the right side, it reaches the right lymphatic duct or the right brachiocephalic vein

Lymphatic drainage of head & neck

• Lymph nodes act as a barrier against disease• They are soft, non-palpable structures• Draining infected, inflamed or areas involved in a

carcinomatous changes will cause the nodes to become swollen, hard, painful and palpable

• They work in groups, primary, secondary and tertiary nodes to combat disease and prevent it from reaching the major lymphatic channels

Lymphatic drainage of head & neck

• Knowledge of the lymphatic drainage in the head and neck will assist in determining the site of the disease

• Cervical metastasis in malignant diseases will require radical “Block resection” surgery to prevent recurrence.– To insure this connective tissues, muscles,

glands, veins and even nerves has to be removed