Lymphatic drainage of the head and neck

1. 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

2. 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

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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