Lymphatic Drainage of Head & Neck

Lymph nodes in head and neck are as follows:

a. Superficial group

b. Deep group

c. Deepest group

SUPERFICIAL GROUP

Buccal and Mandibular Nodes

The buccal node lies on the buccinator, and 

the mandibular node at the lower border of the mandible near the anteroinferior angle of the masseter, 

in close relation to the mandibular branch of the facial nerve.

They drain part of the cheek and the lower eyelid. 

Their efferents pass to the anterosuperior group of deep cervical nodes

Preauricular Nodes

Drain parotid gland, temporal region, middle ear, etc

Postauricular (Mastoid) Nodes

• The postauricular nodes lie on the mastoid process
• superficial to the sternocleidomastoid and deep to the auricularis posterior. 
• They drain a strip of scalp just above and behind the auricle, the upper half of the medial surface and margin of the auricle, and the posterior wall of the external acoustic meatus. 
• Their efferents pass to the posterosuperior group of deep cervical nodes

Occipital Nodes

• The occipital nodes lie at the apex of the posterior triangle superficial to the attachment of the trapezius.
• They drain the occipital region of the scalp. 
• Their efferents pass to the supraclavicular members of the posteroinferior group of deep cervical nodes.

Anterior Superficial Cervical Nodes

• The anterior cervical nodes lie along the anterior jugular vein and are unimportant. 
• The suprasternal lymph node is a member of this group. 
• They drain the skin of the anterior part of the neck below the hyoid bone. 
• Their efferents pass to the deep cervical nodes of both sides

Lateral Superficial Cervical Nodes

• The superficial cervical nodes lie along the external jugular vein superficial to the sternocleidomastoid.
• They  drain the lobule of the auricle, the floor of the external acoustic meatus, and the skin over the lower parotid region and the angle of the jaw. 
• Their efferents pass round both borders of the muscle to reach the upper and lower deep cervical nodes.

DEEP GROUP

1. Submental ond Submandibular Nodes

• Submental nodes lie deep to the chin. 
• These drain the lymph from tip of tongue and anterior part of floor of mouth. 
• The submandibular nodes drain lateral surface of tongue, lower gums and teeth and central area of forehead.

2. Upper lateral Group around lnternal Jugular Vein

• The jugulodigastric node is a member of this group. 
• It lies below the posterior belly of the digastric, between the angle of the mandible and the anterior border of the sternocleidomastoid, in the triangle bounded by the posterior belly of the digastric, the facial vein and the internal jugular vein. 
• It is the main node draining the tonsil.

3. Middle Lateral Group around Internal Jugular vein

• These drain thyroid and parathyroid glands. 
• They receive efferents from prelaryngeal, pretracheal and paratracheal lymph nodes.

4. Lower Lateral Nodes around lnternal Jugular vein

• The jugulo-omohyoid node is a this group. 
• It lies just above the intermediate tendon of the omohyoid, under cover of the posterior border of the 
• sternocleidomastoid. 
• It is the main lymph node of the tongue.

5. Lymph Nodes in Posterior Triangle

• Efferents of the deep cervical lymph nodes join together to form the jugular lymph trunks, one on each side. 
• The left jugular trunk opens into the thoracic duct. 
• The right trunk may open either into the right lymphatic duct, or directly into the angle of junction 
• between the internal jugular and subclavian veins.

DEEPEST GROUP

Prelaryngeal and Pretracheal Nodes

• The prelaryngeal and pretracheal nodes lie deep to the investing fascia, the prelaryngeal nodes on the cricothyroid membrane, and the pretracheal in front of the trachea below the isthmus of the thyroid gland.
• They drain the larynx, the trachea and the isthmus of the thyroid. 
• They also receive afferents from the anterior cervical nodes. 
• Their efferents pass to the nearby deep cervical nodes.

Paratracheal  Nodes

• The paratracheal nodes lie on the sides of the trachea and oesophagus along the recurrent laryngeal nerves.
• They receive lymph from the oesophagus, the trachea and the larynx, and pass it on to the deep cervical nodes.

Retropharyngeal Nodes

• The retropharyngeal nodes lie in front of the prevertebral fascia and behind the buccopharyngeal fascia covering the posterior wall of the pharynx. 
• They extend laterally in front of the lateral mass of the atlas and along the lateral border of the longus capitis. 
• They drain the pharynx, the auditory tube, the soft palate, the posterior part of the hard palate, and the nose. 
• Their efferents pass to the upper lateral group of deep cervical nodes.
• Waldeyer's ring comprises lingual, palatine, tubal and nasopharyngeal tonsils

MAIN LYMPH TRUNKS AT THE ROOT OF THE NECK

1. The thoracic duct is the largest lymph trunk of the body. 

• It begins in the abdomen from the upper end of the cisterna chyli, 
• traverses the thorax, and 
• ends on the left side of the root of the neck by opening into the angle of junction between the left internal jugular vein and the left subclavian vein 
• Before its termination, it forms an arch at the level of the transverse process of vertebra C7 rising 3 to 4 cm above the clavicle. 

The relations of the arch are:

Anterior:

a. Left common carotid artery 

b. Vagus

c. Internal jugular vein.

Posterior:

a. Vertebral artery and vein 

b. Sympathetic trunk

c. Thyrocervical trunk and its branches

d. Prevertebral fascia 

e. Phrenic nerve

f. Scalenus anterior.

Apart from its tributaries in the abdomen and thorax, the thoracic duct receives (in the neck):

a. The left jugular trunk

b. The left subclavian trunk

c. The left bronchomediastinal trunk.

It drains most of the body, except for the right upper limb, the right halves of the head, the neck and the thorax and the superior surface of the liver.

2. The right jugular trunk drains half of the head and neck.

3. The right subclavian trunk drains the upper limb.

4. The bronchomediastinal trunk drains the lung, half of the mediastinum and parts of the anterior walls of the thorax and abdomen.

On the right side, the subclavian, jugular andbronchomediastinal trunks unite to form the right lymph trunk which ends in a manner similar to the thoracic duct

Clinical Anatomy

• The deep cervical lymph nodes lie on the internal jugular vein. These nodes often become adherent to the vein in malignancy or in tuberculosis.
• Therefore, during operation on such patients the vein is also resected. 
• These are examined from behind with the neck slightly flexed.
• Superficial cervical, supraclavicular and lymph nodes of anterior triangle can easily be palpated.
• Chronic infection of the palatine tonsil causes enlargement of jugulo-digastric lymph nodes which adhere to the internal jugular vein.
• Painful enlargement of the submandibular lymph nodes is common because infections in tongue, mouth and cheek are quite common. 
• These nodes may be affected by tubercular bacteria.
• Spinal root of accessory nerve may get entangled in the enlarged lymph nodes situated in the posterior triangle of neck. 
• While taking biopsy of the lymph node, one must be careful not to injure the accessory nerve lest trapezius gets damaged
• The left supraclavicular nodes are called Virchow's lymph nodes. Cancer from stomach and testis may metastasize into these lymph nodes, which may become palpable,

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Lymphatics of Head and Neck | Deep Cervical | Outer Circle | Inner Circle | Area of Drainage |