The Lymphatic Drainage
of
Head and Neck
Introduction
• Lymph is removed from tissues by
lymphatic channels which drain into
regional lymph nodes.
• Efferent channels then drain to more
proximal nodes
• Their efferent then drain into major
veins in the root of neck.
• However, virtually, all nodes have
collateral channels which bypass the
node.
• This accounts for distant metastasis
without involvement of the primary
nodes.
Lymph Tissue of Head & Neck
• Head & Neck is drained by 2 groups of
lymphoid tissue namely:
– (1) Adenoid Tissue
– (2) Lymph Glands.
• (1) Adenoid Tissue surrounds the entrance to
pharynx and is called Waldeyer’s
Lymphatic Ring
• (2) Lymph Glands are arranged in:
(i) Circular Chain and (ii) Vertical Chain.
Lymphatics of the Head & Neck
Waldeyer’s Lymphatic Ring
• Superior:
– Pharyngeal Tonsils or adenoids.
– Site: on roof of pharynx.
• Inferior:
– Lingual tonsil at the base of tongue.
• Laterally:
– Palatine tonsils
Lymphatic Drainage:
– Jugulo-digastric node (superior deep
cervical nodes) main lymph gland of
tonsil
– Situated just below posterior belly of
digastric muscle & angle of lower
jaw and at the junction of common
facial and internal jugular veins
Waldeyer’s Lymphatic Ring
Lymph nodes of the Head and Neck
• Lymph nodes in head & neck
(mainly face and scalp) consist of
– a number of regional groups named
according to region.
• In the neck, lymph nodes consist
of
– Superficial (circular) which all drain
into deep cervical group.
– Deep cervical group (vertical) .
• Superficial lymph nodes are
usually subcutaneous lying along
external jugular vein and
superficial to sternocleidomastoid
muscle.
Regional group of Lymph nodes
• (1) Occipital
• (2) Posterior auricular (Retroauricular)
• (3) Pre-auricular
• (4) Parotid
• (5) Facial
• (6) Submandibular
• (7) Sub-mental
• (8) Superficial cervical –along external
jugular vein
• (9) Anterior cervical-along the anterior
jugular veins
• (10) Retropharyngeal nodes
• (11)Laryngeal
• (12) Tracheal
Regional Lymph nodes: Submental nodes
1. Three to four in number, lie
below chin
2. Some superficial other deep to
investing deep cervical fascia
3. Drain a wedge of tissues in floor
of mouth, lower incisor, gum and
lip, tip of tongue
4. Then drain into submandibular
group or directly into deep
cervical group
Submandibular nodes
– Half a dozen, lie on surface of
submandibular salivary gland or
embedded within it.
– Drain the submental nodes, lateral
part of lower lip, upper lip and
external nose, anterior 2/3 of
tongue.
– Anterior half of nasal walls,
paranasal sinuses and all teeth
except lower anterior.
Buccal and Preauricular nodes
• Preauricular nodes:
– lie within parotid gland
– Drain temporal part, lateral surface
of auricle, anterior wall of external
meatus, and lateral part of eyelids
– Drain into deep cervical group
• Buccal node:
– lies over buccinator muscle on facial
vein
– drain into submandibular group
Posterior auricular and Occipital Nodes
• Posterior auricular nodes:
– situated on lateral of mastoid process
– receive lymph from a scalp above
auricle and posterior border of auditory
meatus
• Occipital nodes:
– situated at the apex of posterior triangle
of neck
– receive lymph from back of scalp
Anterior cervical and Superficial nodes
• Superficial cervical nodes:
– lie along the course of external jugular
vein
– receive lymph from skin over angle of
mandible and over apex of parotid
gland and lobe of ear
• Anterior cervical nodes:
– situated along the course of anterior
jugular vein
– receive lymph from skin and
superficial tissues of the front of neck.
Retropharyngeal,Laryngeal and Tracheal
Nodes
• Retropharyngeal nodes:
– lie in retropharyngeal space,
between pharyngeal wall and
prevertebral fascia
– receive lymph from nasal part of
pharynx, auditory tube and upper
cervical vertebrae
• Laryngeal nodes:
– in front of larynx
• Tracheal nodes:
– lateral and in front of trachea
– receive from thyroid gland
Deep Cervical Lymph nodes
• These glands form a vertical chain
extending from base of skull to root of
neck.
• scatter in carotid sheath, in front and
behind internal jugular vein along its
course.
• They lie along the side of pharynx,
trachea and oesophagus
• They lie undercover of
sternocleidomastoid muscle.
• Divided into upper and lower groups
and they are connected by lymphatic
channels.
• Two of nodes are clinically known as
Jugulodigastric and jugulo-omohyoid
Upper group and Jugulo-diagastric Nodes
• Upper group:
– Receive lymph from posterior part
of the tongue, tonsil, ear, nose,
sinuses, upper part of pharynx and
larynx.
– Jugulo-digastric nodes lie just below
posterior belly of digastric muscle,
and is clinically palpable below
angle of mandible.
– Drain the back of tongue and tonsils
Lower group and Jugulo-omohyoid nodes
• Lower group:
– Receive lymph from anterior
part of face, scalp, anterior
two third of tongue, lower
part of pharynx and larynx
and thyroid gland.
– Jugulo-omohyoid nodes
related to intermediate
tendon of omohyoid muscle
and is concerned with
drainage of lymph from
anterior part of tongue
Lymphatic Drainage of the Tongue
Jugular Lymph Trunk
• Deep cervical nodes
received lymph from
regional nodes of head &
neck.
• Efferent lymph vessels
join to form jugular
lymph trunk.
• This vessel drains into
thoracic duct or right
lymph duct
• Right Lymph duct and
thoracic ducts drain into
subclavian veins
Major lymph trunks & Drainage area
Applied Anatomy
• Lymph nodes are soft, non-palpable
structures
• Lymph nodes act as a barrier against
disease
• They work in groups, primary, secondary
and tertiary nodes to combat disease and
prevent it from reaching major lymphatic
channels
• Lymphangitis & lymphadenitis are
common manifestations of a bacterial
infection.
Applied Anatomy
• Red streaks from wound or area of
cellulitis (Inflammation of connective
tissue) lead to regional lymph nodes
as fluid is filtered and foreign
substances phagocytosed
• The nodes become swollen, hard,
painful and palpable
• The position of swollen ,tender nodes
denotes general location of infection
Applied Anatomy
• Draining areas involved in a carcinomatous changes
cause the nodes to become involved, becoming
enlarged and stony hard but not painful.
• In Hodgkin’s disease and metastasis of malignant
diseases cervical lymph nodes are painlessly
enlarged.
• They can also be enlarged in lymphomas & other
lymphatic diseases.
Applied Anatomy
• Knowledge of lymphatic drainage in head and neck
will assist in determining the site of 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
– Anatomy of nerves and vessels and lymph nodes are
important for surgeon
