Download MBBS Anatomy PPT 45 Anatomy Of Neck Notes

Lymphatic Drainage Of Head and Neck

? Lymph nodes acts as a barrier against disease.

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? They are soft non palpable structure

? Draining infected , inflamed or area involved in

carcinomatous changes will cause the nodes to

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become swollen , hard , painful and palpable

? They prevent disease from reaching major

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lymphatic channels

? Position of nodes denotes general location of

infection

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Lymphatic Drainage Of Head and Neck

Lymph nodes in the head and neck are

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arranged in

A. Two horizontal rings and

B. Two vertical chains on either side of the

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neck.

Lymphatic Drainage Of Head and Neck

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A. Two horizontal rings

a) Outer superficial ring (pericervical ring.)
at junction of head and neck consists of

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?

Occipital

?

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Retro-auricular

?

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preauricular (parotid)

?

submandibular

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?

submental nodes

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S. No

Nodes

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Location

1

Occipital (2-4)

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Superior nuchal line between

sternocleidomastoid and

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trapezius

2

Mastoid (1-3),or

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Superficial to

Retroauricular

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sternocleidomastoid

insertion

3

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Preauricular (2-3)parotid

Anterior to ear over parotid

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fascia

S.NO

Nodes

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Location

4

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Parotid (up to 10 or

About parotid gland

more)

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and under parotid
fascia
Deep to parotid
gland

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5

Submental (2-3)

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Submental triangle

6

Submandibular

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Submandibular

(3-6)

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triangle adjacent
to submandibular
gland

Few Outlying Nodes

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Facial

Superficial(up to 12) Distributed along

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Skin and mucous

Submandibular

Maxillary

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course of facial

membranes of

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nodes

Buccal

artery and vein

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eyelids, nose, cheek

Mandibular
Deep

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Distributed along

Temporal and

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Superior deep

course of maxillary

infratemporal fossa cervical lymph

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artery lateral to

Nasal pharynx

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nodes

lateral pterygoid

muscle

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Lymphatic Drainage Of Head and Neck

A. Two horizontal rings

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b) Inner deep ring is formed by clumps of
mucosa associated lymphoid tissue (MALT) located
primarily in the naso- and oro-pharynx (Waldeyer's
ring).

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Waldeyer's tonsil ar ring, consist of

a) Unpaired pharyngeal tonsil in the roof of the pharynx,

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b) Paired palatine tonsils and

c) Lingual tonsils scat ered in the root of the tongue.

Superficial and deep vertical Chains of cervical

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nodes

a) Superficial Vertical Chain

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I. Along external Jugular vein-called

superficial cervical LN

I . Along anterior Jugular vein- called

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anterior cervical LN

Superficial Vertical Chain

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i. Along external

Jugular vein-called

superficial cervical

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LN

i . Along anterior

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Jugular vein- called

anterior cervical LN

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Deep vertical chain

consists of superior and

inferior groups of deep

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cervical nodes related

to the carotid sheath

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Deep cervical glands

Numerous and of large size:

Form a chain along the carotid sheath, lying by

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the side of the pharynx, esophagus, and trachea,

and extending from the base of the skull to the root

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of the neck.

Deep cervical glands

They are usually described in two groups:

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(1) Superior deep cervical glands lying under the

Sternocleidomastoid in close relation with the internal

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jugular vein, some of the glands lying in front of and others

behind the vessel;

Jugulodigastric LN- Part of superior deep cervical group

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of LN at Junction of internal jugular vein and posterior

digastric muscle
Deep cervical glands

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They are usually described in two groups:

(2) Inferior deep cervical glands may extend beyond the

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posterior margin of the Sternocleidomastoideus into the

supraclavicular triangle, where they are closely related to

the brachial plexus and subclavian vein.

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Jugulo-omohyoid - Above junction of internal jugular vein

and omohyoid muscle

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Few outlying LN

Accessory (2-6)

Along accessory

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Occipital nodes

Transverse cervical

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nerve in posterior

Mastoid nodes

nodes

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triangle

Lateral neck and

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shoulder

Transverse cervical Along transverse

Accessory nodes

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Jugular trunk or

(1-10)

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cervical blood

Apical axillary nodes directly into thoracic

vessels at level of

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Lateral neck

duct or right

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clavicle

Anterior thoracic

lymphatic duct or

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wall

independently into

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junction of internal

jugular vein and

subclavian vein

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All lymph vessels of the head and neck drain

into the inferior deep cervical nodes, either

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directly from the tissues or indirectly via

nodes in outlying groups.

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Paravisceral deep nodes-

? Retropharyngeal(lie in the buccopharyngeal

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fascia, behind the upper part of the pharynx )

? Infrahyoid (Ant. to thyrohyoid membrane )
? Prelaryngeal( On conus elasticus and cricovocal

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membrane)

? Pretracheal(Ant to trachea)
? Paratracheal(Along RLN)
? Subclavian(Subclavian triangle)

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Deep vertical chain receive in addition to direct

area of drainage

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- All efferent from pericervical ring
- Efferents from superficial cervical nodes
- Efferents from other paravisceral deep nodes-retropharyngeal,

infrahyoid,prelaryngeal,pretracheal,paratracheal,subclavian

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Final drainage of lymph

All lymph from head and neck finally drain to ipsilateral

lower deep cervical LN- Terminal group

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Efferent- Jugular lymph trunk- terminate at or near

jugulosubclavian venous junction

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On left side usually joins the thoracic duct

on the right side either joins the right lymphatic duct or

empties independently at the junction of the IJV and

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subclavian vein