Download MBBS Anatomy PPT 61 Anatomy Of Neck Nodes 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)

?

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submandibular

?

submental nodes

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S. No

Nodes

Location

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1

Occipital (2-4)

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Superior nuchal line between

sternocleidomastoid and

trapezius

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2

Mastoid (1-3),or

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Superficial to

Retroauricular

sternocleidomastoid

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insertion

3

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Preauricular (2-3)parotid

Anterior to ear over parotid

fascia

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S.NO

Nodes

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Location

4

Parotid (up to 10 or

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About parotid gland

more)

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and under parotid
fascia
Deep to parotid
gland

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5

Submental (2-3)

Submental triangle

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6

Submandibular

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Submandibular

(3-6)

triangle adjacent

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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

b) Inner deep ring is formed by clumps of

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mucosa associated lymphoid tissue (MALT) located
primarily in the naso- and oro-pharynx (Waldeyer's
ring).

Waldeyer's tonsil ar ring, consist of

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

b) Paired palatine tonsils and

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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

I. Along external Jugular vein-called

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superficial cervical LN

I . Along anterior Jugular vein- called

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anterior cervical LN

Superficial Vertical Chain

i. Along external

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Jugular vein-called

superficial cervical

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LN

i . Along anterior

Jugular vein- called

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anterior cervical LN


Deep vertical chain

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consists of superior and

inferior groups of deep

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cervical nodes related

to the carotid sheath
Deep cervical glands

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Numerous and of large size:

Form a chain along the carotid sheath, lying by

the side of the pharynx, esophagus, and trachea,

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and extending from the base of the skull to the root

of the neck.

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Deep cervical glands

They are usually described in two groups:

(1) Superior deep cervical glands lying under the

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Sternocleidomastoid in close relation with the internal

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

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behind the vessel;

Jugulodigastric LN- Part of superior deep cervical group

of LN at Junction of internal jugular vein and posterior

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digastric muscle
Deep cervical glands

They are usually described in two groups:

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(2) Inferior deep cervical glands may extend beyond the

posterior margin of the Sternocleidomastoideus into the

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supraclavicular triangle, where they are closely related to

the brachial plexus and subclavian vein.

Jugulo-omohyoid - Above junction of internal jugular vein

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and omohyoid muscle

Few outlying LN

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Accessory (2-6)

Along accessory

Occipital nodes

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Transverse cervical

nerve in posterior

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Mastoid nodes

nodes

triangle

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Lateral neck and

shoulder

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Transverse cervical Along transverse

Accessory nodes

Jugular trunk or

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(1-10)

cervical blood

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Apical axillary nodes directly into thoracic

vessels at level of

Lateral neck

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duct or right

clavicle

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Anterior thoracic

lymphatic duct or

wall

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independently into

junction of internal

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jugular vein and

subclavian vein

All lymph vessels of the head and neck drain

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into the inferior deep cervical nodes, either

directly from the tissues or indirectly via

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nodes in outlying groups.


Paravisceral deep nodes-

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? Retropharyngeal(lie in the buccopharyngeal

fascia, behind the upper part of the pharynx )

? Infrahyoid (Ant. to thyrohyoid membrane )

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? Prelaryngeal( On conus elasticus and cricovocal

membrane)

? Pretracheal(Ant to trachea)

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? Paratracheal(Along RLN)
? Subclavian(Subclavian triangle)
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,

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

All lymph from head and neck finally drain to ipsilateral

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lower deep cervical LN- Terminal group

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

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empties independently at the junction of the IJV and

subclavian vein