Download MBBS Anatomy PPT 45 Anatomy Of Neck Notes

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Lymphatic Drainage Of Head and Neck

? Lymph nodes acts as a barrier against disease.

? They are soft non palpable structure

? Draining infected , inflamed or area involved in

carcinomatous changes will cause the nodes to

become swollen , hard , painful and palpable

? They prevent disease from reaching major

lymphatic channels

? Position of nodes denotes general location of

infection

Lymphatic Drainage Of Head and Neck

Lymph nodes in the head and neck are

arranged in

A. Two horizontal rings and

B. Two vertical chains on either side of the

neck.

Lymphatic Drainage Of Head and Neck

A. Two horizontal rings

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

?

Occipital

?

Retro-auricular

?

preauricular (parotid)

?

submandibular

?

submental nodes


S. No

Nodes

Location

1

Occipital (2-4)

Superior nuchal line between

sternocleidomastoid and

trapezius

2

Mastoid (1-3),or

Superficial to

Retroauricular

sternocleidomastoid

insertion

3

Preauricular (2-3)parotid

Anterior to ear over parotid

fascia

S.NO

Nodes

Location

4

Parotid (up to 10 or

About parotid gland

more)

and under parotid
fascia
Deep to parotid
gland

5

Submental (2-3)

Submental triangle

6

Submandibular

Submandibular

(3-6)

triangle adjacent
to submandibular
gland

Few Outlying Nodes

Facial

Superficial(up to 12) Distributed along

Skin and mucous

Submandibular

Maxillary

course of facial

membranes of

nodes

Buccal

artery and vein

eyelids, nose, cheek

Mandibular
Deep

Distributed along

Temporal and

Superior deep

course of maxillary

infratemporal fossa cervical lymph

artery lateral to

Nasal pharynx

nodes

lateral pterygoid

muscle


Lymphatic Drainage Of Head and Neck

A. Two horizontal rings

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).

Waldeyer's tonsil ar ring, consist of

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

b) Paired palatine tonsils and

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

Superficial and deep vertical Chains of cervical

nodes

a) Superficial Vertical Chain

I. Along external Jugular vein-called

superficial cervical LN

I . Along anterior Jugular vein- called

anterior cervical LN

Superficial Vertical Chain

i. Along external

Jugular vein-called

superficial cervical

LN

i . Along anterior

Jugular vein- called

anterior cervical LN


Deep vertical chain

consists of superior and

inferior groups of deep

cervical nodes related

to the carotid sheath

Deep cervical glands

Numerous and of large size:

Form a chain along the carotid sheath, lying by

the side of the pharynx, esophagus, and trachea,

and extending from the base of the skull to the root

of the neck.

Deep cervical glands

They are usually described in two groups:

(1) Superior deep cervical glands lying under the

Sternocleidomastoid in close relation with the internal

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

behind the vessel;

Jugulodigastric LN- Part of superior deep cervical group

of LN at Junction of internal jugular vein and posterior

digastric muscle
Deep cervical glands

They are usually described in two groups:

(2) Inferior deep cervical glands may extend beyond the

posterior margin of the Sternocleidomastoideus into the

supraclavicular triangle, where they are closely related to

the brachial plexus and subclavian vein.

Jugulo-omohyoid - Above junction of internal jugular vein

and omohyoid muscle

Few outlying LN

Accessory (2-6)

Along accessory

Occipital nodes

Transverse cervical

nerve in posterior

Mastoid nodes

nodes

triangle

Lateral neck and

shoulder

Transverse cervical Along transverse

Accessory nodes

Jugular trunk or

(1-10)

cervical blood

Apical axillary nodes directly into thoracic

vessels at level of

Lateral neck

duct or right

clavicle

Anterior thoracic

lymphatic duct or

wall

independently into

junction of internal

jugular vein and

subclavian vein


All lymph vessels of the head and neck drain

into the inferior deep cervical nodes, either

directly from the tissues or indirectly via

nodes in outlying groups.


Paravisceral deep nodes-

? Retropharyngeal(lie in the buccopharyngeal

fascia, behind the upper part of the pharynx )

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

membrane)

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

Deep vertical chain receive in addition to direct

area of drainage

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

infrahyoid,prelaryngeal,pretracheal,paratracheal,subclavian
Final drainage of lymph

All lymph from head and neck finally drain to ipsilateral

lower deep cervical LN- Terminal group

Efferent- Jugular lymph trunk- terminate at or near

jugulosubclavian venous junction

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

subclavian vein