Human Anatomy, Part 2 - K. A. Dyubenko, A. K. Kolomiysev, Yu. B. Chaykovsky 2008

Special Part
The Lymphatic System (systema lymphaticum [systema lymphoideum]) - General Overview
Lymphatic Vessels and Regional Nodes of Specific Body Regions and Organs - Lymphatic Vessels and Nodes of the Head and Neck

The Lymphatic vessels of the HEAD and Neck are divided into superficial and deep. They drain Lymph from the structures of the head and neck into the right and left jugular trunks (truncus jugularis dexter et sinister). These trunks accompany the Internal jugular vein and empty as follows: the left jugular trunk drains into the left venous angle or the Thoracic duct, whereas the right jugular trunk drains into the Right lymphatic duct or directly into the right venous angle. Along the course of the jugular trunk, there are numerous regional Lymph Nodes through which lymph must pass before reaching the lymphatic duct. Among the regional lymph nodes of the head, the following are distinguished:

1. Occipital lymph nodes (nodi lymphatici occipitales), located above and beneath the Superficial layer of the Cervical fascia, as well as in the region where the nuchal Muscles attach to the Occipital bone and relative to m. splenius capitis. Afferent lymphatic vessels approach the occipital lymph nodes, draining lymph from the Skin of the occipital region and the deep Tissues of the back of the head.

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Fig. 107. Lymphatic vessels and nodes of the mammary gland and axillary region

Efferent lymphatic Vessels of the occipital nodes are directed toward the lateral deep cervical lymph nodes.

2. Mastoid lymph nodes, nodi lymphatici mastoidei (retroauriculares), located behind the auricle on the mastoid process, which is why they are also referred to as retroauricular nodes. They drain lymph from the skin of the parietal region, the posterior surface of the auricle, the tympanic membrane, and the external acoustic meatus. The efferent vessels of these nodes pass toward the parotid, superficial, and deep cervical lymph nodes.

3. Parotid lymph nodes, nodi lymphatici parotidei, located within the region of the parotid gland. They are subdivided into superficial and deep groups. They receive lymphatic vessels that collect lymph from the temporal, frontal, and parietal Regions of the head, the lateral part of the eyelids, the upper lip, the auricle, the parotid gland, the temporomandibular joint, the external acoustic meatus, the tympanic membrane, and the auditory tube. Efferent lymphatic vessels of the parotid nodes drain lymph into the superficial and lateral deep cervical lymph nodes.

4. Facial lymph nodes, nodi lymphatici faciales (including deep buccal, nasolabial, mandibular, and molar nodes), collect lymph from the facial muscles, the mucosa of the Lips, Cheeks, and Gums, the mucous Glands of the Oral Cavity, the periosteum of the oral and nasal regions, the sublingual and submandibular Salivary Glands, and the Eyeball.

5. Lingual lymph nodes, nodi lymphatici linguales, are located along the path of the lingual artery and vein on the outer surface of the geniohyoid Muscle and between the right and left geniohyoid muscles. Afferent vessels drain lymph from various PARTS OF THE Tongue. Efferent vessels convey lymph to the deep cervical lymph nodes of the jugular chain, the retropharyngeal nodes, and the submandibular nodes.

6. Submental lymph nodes, nodi lymphatici submentales, are situated in the area between the Mandible and the Hyoid bone, on the Inferior surface of the geniohyoid muscle and between the anterior bellies of the right and left digastric muscles. The submental nodes collect lymph from the skin of the chin, the lower lip, the tongue, the gums, and the Teeth. Efferent lymphatic vessels pass into the deep cervical nodes surrounding the internal jugular vein and into the jugulo-omohyoid lymph node.

7. Submandibular lymph nodes, nodi lymphatici submandibulares, are located within the submandibular triangle on the external surface of the body of the mandible, anterior and posterior to the submandibular gland, as well as within the gland itself and around the facial artery and vein. Lymphatic vessels drain lymph from the following areas: the skin of the upper and lower lips, Nose, cheek, chin, inner part of the lower eyelid, mucosa of the Nasal cavity, tongue, palate, gums, teeth, and the sublingual and submandibular salivary glands. Efferent vessels convey lymph from the submandibular nodes to the lateral deep cervical lymph nodes.

The lymph nodes of the neck are divided into two groups:

1) anterior cervical lymph nodes, nodi lymphatici cervicales anteriores, and

2) lateral cervical lymph nodes, nodi lymphatici cervicales laterales.

Among the anterior cervical lymph nodes, the following are distinguished: superficial (superficiales, or anterior jugular [jugulares anteriores]) and deep (profundi). According to the Terminologia Anatomica (LNA), the deep group includes subhyoid, infrahyoid, thyroid, pretracheal, paratracheal, and retropharyngeal nodes.

The lateral cervical lymph nodes are also subdivided into superficial and deep. The superficial lymph nodes lie on the sternocleidomastoid muscle along the External Jugular Vein, whereas the deep lymph nodes form the largest chain extending from superior to inferior along the internal jugular vein. In the cervical region, along the transverse cervical artery, there is another chain (supraclavicular nodes), as well as a third chain running along the Accessory nerve, obliquely from top to bottom and posteriorly. All these nodes receive lymph from the skin, muscles, BONES OF THE head and neck, Sense Organs, and the Internal Organs of the head and neck.

Among the deep nodes, the jugulodigastric and jugulo-omohyoid nodes deserve special attention because they receive lymph from the tongue and are common sites for metastasis in malignant tumors. The jugulodigastric node is located at the crossing of the posterior belly of the digastric muscle with the internal jugular vein, whereas the jugulo-omohyoid node is situated where the belly of the omohyoid muscle (m. omohyoideus) abuts the anterior surface of the internal jugular vein.

Retropharyngeal lymph nodes, nodi lymphatici retropharyngeales, are located posterior to the Pharynx near its lateral margin. Lymph flows through afferent vessels from the nasal cavity, Paranasal Sinuses, Hard and Soft palate, Middle ear, auditory tube, Tonsils, and the nasal and oral parts of the pharynx. Efferent lymphatic vessels of the retropharyngeal nodes drain into the deep cervical lymph nodes.

*If the tongue is affected by a malignant tumor, metastasis may occur in the deep cervical lymph nodes of the jugular chain and in the retropharyngeal nodes. When performing surgery for a malignant tumor of the tongue, the surgeon must remove not only the tongue but also all the lymph nodes of the neck.