Download Veins of the Head and neck

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