Anatomy of the Vessels and Nerves of the Head and Neck (Angioneurotomy) - Chornokulskyi S.T. 2009

Lymphatic vessels and nodes of the head and neck

The regional Lymph Nodes of the HEAD (nodi lymphoidei capitis) are located along the border between the Head and Neck and are represented by the following groups:

1. Occipital nodes (nodi occipitales);

2. Mastoid nodes (nodi mastoidei);

3. Superficial and deep parotid nodes (nodi parotidei superficiales et profundi);

4. Facial nodes (nodi faciales);

5. Lingual nodes (nodi linguales);

6. Submental nodes (nodi submentales);

7. Submandibular nodes (nodi submandibulares);

8. Mandibular node (nodus mandibularis).

Lymph from the Tissues and Organs of specific Regions of the head drains into the aforementioned regional lymph nodes. Specifically, into the submental nodes situated between the anterior bellies of the digastric Muscles, afferent Lymphatic vessels transport lymph from the floor of the Oral Cavity, the apex of the Tongue, and the lower lip.

The submandibular nodes, located within the trigonum submandibulare, receive efferent lymphatic vessels from the facial (buccal), submental, and mandibular nodes, which collectively drain lymph from the Skin of the face, the soft Tissues of the eyelids, Nose, Lips, the buccal mucosa, gingiva, Teeth, jaws, Hard and Soft palates, the body of the tongue, and adjacent Salivary Glands.

Efferent lymphatic vessels from the submandibular nodes deliver lymph to the lateral deep cervical nodes.

Lymph nodes of the neck (nodi lymphoidei colli) [Fig. 261

Depending on their Location relative to the Superficial layer of the Cervical fascia, they are divided into:

— superficial cervical nodes (nodi cervicales superficiales) (lying upon the lamina superficialis);

— deep cervical nodes (nodi cervicales profundi) (situated beneath the lamina superficialis).

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Fig. 25. General diagram of lymphatic transport pathways.

A:

1 - termination site of the Thoracic duct (75% of lymph) — into the left venous angle;

2 - thoracic duct (ductus thoracicus);

3 - lymph node (nodus lymphoideus);

4 - Blood capillary (hemocapillary);

5 - intercellular space;

6 - lymphatic capillary (lymphocapillary).

B:

3 - lymph node with lymphatic vessels;

7 - lymphatic vessel with a valve in cross section;

8 - efferent lymphatic vessel (vas lymphaticum efferens);

9 - valve and valve sinus (valvula et sinus valvulae) (in section);

10 - afferent lymphatic vessels (vasa lymphatica afferentia)

Fig. 26. Lymph nodes of the head and neck (arrows indicate the direction of lymph flow)

1 - buccal node (nodus buccinatorius);

2 - submental nodes (nodi submentales);

3 - submandibular nodes (nodi submandibulares);

4-7 - lateral deep cervical nodes (nodi cervicales profundi laterales);

5 - anterior superficial cervical nodes (nodi cervicales superficiales anteriores);

6 - supraclavicular nodes (nodi supraclaviculares);

8 - parotid nodes (nodi parotidei);

9 - mastoid nodes (nodi mastoidei);

10 - occipital nodes (nodi occipitales)

Fig. 26 a. Lymphatic trunks and ducts of The Human Body:

1 - left jugular trunk (truncus jugularis sinister);

2 - left subclavian trunk (truncus subclavius sinister);

3 - left bronchomediastinal trunk (truncus bronchomediastinalis sinister);

4 - Right lymphatic duct (ductus lymphaticus dexter);

5 - thoracic duct (ductus thoracicus);

6 - cisterna chyli (cisterna chyli);

7 - intestinal trunks (truncι intestinales);

8 - lumbar trunk (truncus lumbalis)

The superficial cervical lymph nodes (nodi cervicales superficiales) are divided into three groups:

— anterior — located along the Anterior jugular vein;

— lateral — located along the External Jugular Vein;

— posterior — located along the anterior border of the trapezius Muscle.

The efferent lymphatic vessels of these nodes run toward the lateral deep cervical nodes situated along the Internal jugular vein.

Deep cervical lymph nodes (nodi cervicales profundi)

are subdivided into two groups:

— anterior and lateral, which are concentrated in the anterior and lateral regions of the neck, respectively.

The anterior deep cervical nodes (4-17)* include:

— prelaryngeal nodes (nodi prelaryngei);

— thyroid nodes (nodi thyroidei):

— pretracheal nodes (nodi pretracheales);

— paratracheal nodes (nodi paratracheales);

— retropharyngeal nodes (nodi retropharуngei);

The Lateral group of deep cervical nodes (11-68) comprises:

— upper deep nodes (nodi profundi superiores);

— lower deep nodes (nodi profundi inferiores).

✵ The upper deep cervical nodes are located anteriorly and laterally to the internal jugular vein (nodi anteriores et laterales). The jugulodigastric node (nodus jugulodigastricus) is situated at the crossing of the internal jugular vein and the posterior belly of the digastric muscle; it is the largest node in this group and can be palpated during inflammations of the tongue, Tonsils, or Pharynx.

The efferent lymphatic Vessels of the upper deep lateral cervical nodes form the jugular trunk (truncus jugularis).

✵ The lower deep cervical nodes are located along the longus capitis muscle on the prevertebral fascia posterior to the pharynx (retropharyngeal nodes — 1—3); between the internal jugular vein and the omohyoid muscle (nodus juguloomohyoideus); as well as the supraclavicular nodes. The efferent vessels of these lower deep cervical nodes drain into the jugular trunk. The right jugular trunk empties into the right lymphatic duct system (ductus lymphaticus dexter), while the left empties into the thoracic duct system (ductus thoracicus), which collects 75% of human lymph (Fig. 25 A).

* The numbers indicate the quantity of lymph nodes.