Lymphatic vessels and nodes of the head and neck

From the head organs, the lymphatic vessels deliver lymph to the lymph nodes located in small groups on the border of the head and neck [occipital, mammillary (behind the ear), parotid, retropharyngeal, facial, submandibular, submental]. From these nodes, the lymph is directed through the vessels to the superficial and deep lymph nodes of the neck (anterior, lateral, posterior), into which the vessels from the neck organs also flow. The efferent lymphatic vessels of the lymph nodes of the largest cervical chain - the lateral deep cervical (internal jugular) lymph nodes form the jugular (lymphatic) trunk.

The occipital lymph nodes (nodi lymphatici occipitales, 1-6 in total) are located on the superficial leaflet of the cervical fascia, behind the attachment of the sternocleidomastoid muscle, and also under this leaflet on the splenius capitis muscle and under this muscle near the occipital blood vessels. The occipital lymph nodes receive lymphatic vessels from the skin of the occipital region and from the deep tissues of the occiput. The efferent lymphatic vessels of the occipital nodes are directed to the lateral deep cervical lymph nodes (nodes of the accessory nerve chain).

The mastoid (behind the ear) lymph nodes (nodi lymphatici mastoidei, 1-4 in total) are located behind the auricle on the mastoid process, at the attachment site of the sternocleidomastoid muscle. They receive lymphatic vessels with lymph from the auricle and the skin of the parietal region. The efferent lymphatic vessels of these nodes are directed to the parotid, superficial cervical (near the external jugular vein) and to the lateral deep cervical (internal jugular) lymph nodes.

The parotid lymph nodes (nodi lymphatici parotidei) are located in the area of the salivary gland of the same name. Outside (laterally) from this gland lie the superficial parotid lymph nodes (1-4), and under the capsule of the gland and in the thickness of the parotid gland, between its lobes, are small deep parotid (intraglandular) lymph nodes (4-10). Lymphatic vessels from the skin and other organs of the frontal and parietal regions of the head, from the auricle, external auditory canal, auditory tube, upper lip, parotid gland are directed to the parotid lymph nodes. The efferent lymphatic vessels of these nodes approach the superficial (near the external jugular vein) and lateral deep (along the internal jugular vein) cervical lymph nodes.

The retropharyngeal lymph nodes (nodi lymphatici retropharyngeals, 1-3 in total) are located on the prevertebral plate of the cervical fascia behind the pharynx and on its lateral walls. Lymphatic vessels from the walls of the pharynx, the mucous membrane of the nasal cavity and paranasal (paranasal) sinuses, from the tonsils and palate, the auditory tube and the tympanic cavity of the middle ear are directed to these nodes. The efferent lymphatic vessels of the retropharyngeal nodes flow into the lateral deep cervical (internal jugular) lymph nodes.

The mandibular lymph nodes (nodi lymphatici mandibulares, 1-3 in total) are inconstant and lie in the subcutaneous tissue on the outer surface of the body of the lower jaw, near the facial artery and vein. In the subcutaneous tissue (cellulose) of the cheek, near the facial vessels, there are also inconstant (1-2) facial (cheek) lymph nodes (nodi lymphatici faciales, s.buccinatorii). The vessels from the skin of the face, soft tissues of the eyelid, nose, lips, and cheek are directed to the lymph nodes of these groups. Their efferent vessels flow into the submandibular lymph nodes (nodi lymphatici submandibulares, 6-8 in total), which lie in a chain under the body of the lower jaw in the submandibular triangle. The lymphatic vessels of the submandibular nodes are directed downwards along the facial vein and flow into the lateral deep cervical (internal jugular) lymph nodes. The submental lymph nodes (nodi lymphatici submentales, 1-8 in total) are located on the lower surface of the geniohyoid muscle, between the anterior bellies of the right and left digastric muscles, extending from the chin to the body of the hyoid bone.

The division of the lymph nodes of the neck is based on their relation to the superficial plate of the cervical fascia, as well as to the large blood vessels of the neck. In this regard, superficial cervical lymph nodes are distinguished, lying on the superficial plate, and deep ones, located under it. Separate regional groups of lymph nodes are located near large vessels - veins of the neck.

The superficial cervical lymph nodes (nodi lymphatici cervicales superficiales, 1-5 in total), occurring in 3/4 of cases, are located near the external jugular vein (1-3 nodes), on the trapezius muscle (1-2 nodes), in the back of the neck and, rarely, near the anterior jugular vein (1 node). Their efferent lymphatic vessels are directed to the lateral deep cervical lymph nodes, located near the internal jugular vein and the external branch of the accessory nerve.

Deep cervical lymph nodes (nodi lymphatici cervicales profundi) are concentrated in the anterior and lateral regions of the neck. The anterior deep cervical lymph nodes include the prelaryngeal (nodi lymphatici prelaryngeales, 1-2 in total), thyroid (nodi lymphatici thyroidei, 1-2 in total), pretracheal (nodi lymphatici pretracheales, 1-8 in total), and paratracheal (nodi lymphatici paratracheales, 1-7 in total), which lie next to the trachea. In the lateral region of the neck, there are numerous lymph nodes (11-68), which form several regional groups. These are the lateral cervical deep (internal jugular) lymph nodes (nodi lymphatici cervicales laterales profundi, 7-60 in total). They are located near the internal jugular vein; 1-8 lymph nodes in the form of a chain are adjacent to the external branch of the accessory nerve. Near the superficial branch of the transverse cervical artery there are from 1 to 8 lymph nodes. In the lateral region of the neck there are also temporary lymph nodes (1-2) lying on the splenius capitis muscle. Through the efferent lymphatic vessels of these nodes, lymph flows to the lateral cervical deep lymph nodes, which are adjacent to the internal jugular vein on all its sides - from the base of the skull to the place of confluence with the subclavian vein. In the group of lateral cervical deep lymph nodes, the jugular-digastric node (nodus jugulodigastricus) and the jugular-scapular-hyoid node (nodus juguloomohyoideus) are distinguished, to which the lymphatic vessels of the tongue are directed mainly. The first of these nodes is located at the level of the intersection of the posterior belly of the digastric muscle with the internal jugular vein, and the second is at the place where the belly of the omohyoid muscle is adjacent to the surface of the anterior internal jugular vein.

The efferent lymphatic vessels of the lateral cervical deep lymph nodes form on each side of the neck the jugular trunk (truncus jugularis, dexter et sinister). This trunk flows into the venous angle, or into one of the veins forming it on the corresponding side, or into the right lymphatic duct and the terminal part of the thoracic duct (on the left).

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