Lymph Drainage of the Head and Neck The lymph nodes in the head and neck are made

up of a number of regional groups and a terminal group. The regional groups comprise: 1) the occipital, 2) the retroauricular (mastoid), 3) the parotid, 4) the buccal (facial), ) the submandibular, !) the submental, ") the anterior cer#ical, $) the superficial cer#ical, %) the retropharyngeal, 1&) the laryngeal, and 11) the tracheal. The terminal group of nodes recei#es all the lymph #essels of the head and neck, either directly or indirectly, #ia one of the regional groups. The terminal group is closely related to the carotid sheath, and, in particular, to the internal 'ugular #ein, and is referred to as the deep cer#ical group. Regional Groups of Lymph Nodes The occipital lymph nodes are situated o#er the occipital bone at the ape( of the posterior triangle of the neck. They recei#e lymph from the back of the scalp. The efferent lymph #essels drain into the deep cer#ical lymph nodes. The retroauricular (mastoid) lymph nodes are situated o#er the lateral surface of the mastoid process of the temporal bone. They recei#e

lymph from a strip of scalp abo#e the auricle and from the posterior )all of the e(ternal auditory meatus. The efferent lymph #essels drain into the deep cer#ical lymph nodes. The parotid lymph nodes are situated on or )ithin the parotid sali#ary gland and they recei#e lymph nodes from a strip of scalp abo#e the parotid sali#ary gland, from the lateral surface of the auricle and the anterior )all of the e(ternal auditory meatus, and from the lateral parts of the eyelids. The nodes that are deeply placed in the parotid sali#ary gland also recei#e lymph from the middle ear. The efferent lymph #essels drain into the deep cer#ical lymph nodes. The buccal (facial) lymph nodes are situated o#er the buccinator muscle, close to the facial #ein. They lie along the course of lymph #essels that ultimately drain into the submandibular nodes. The submandibular lymph nodes are situated on the superficial surface of the submandibular sali#ary gland, beneath the in#esting layer of deep cer#ical fascia. They may be palpated 'ust belo) the lo)er border of the body of the mandible. They recei#e lymph from a )ide area, including the front of the scalp* the nose and ad'acent cheek* the upper lip and the lo)er lip (e(cept the center part)* the frontal, ma(illary and ethmoid air sinuses* the upper and lo)er teeth (e(cept the lo)er incisors)* the anterior

t)o+thirds of the tongue (e(cept the tip)* the floor of the mouth and #estibule* and the gums. The efferent lymph #essels drain into the deep cer#ical lymph nodes. The submental lymph nodes are situated in the submental triangles bet)een the anterior belies of the digastric muscles. They recei#e lymph from the tip of the tongue, the floor of the mouth beneath the tip of the tongue, the incisor teeth and the associated gums, the center part of the lo)er lip, and the skin o#er the chin. The efferent lymph #essels drain into the submandibular and deep cer#ical lymph nodes. The anterior cer#ical lymph nodes are situated along the course of the anterior 'ugular #eins. They recei#e lymph from the skin and superficial tissues of the front of the skin and superficial tissues of the front of the neck. The efferent lymph #essels drain into the deep cer#ical lymph nodes. The superficial cer#ical lymph nodes are situated along the course of the e(ternal 'ugular #ein. They recei#e lymph from the skin o#er the angle of the 'a), the skin o#er the ape( of the parotid sali#ary gland, and the lobe of the ear. The efferent lymph #essels drain into the deep cer#ical lymph nodes.

The retropharyngeal lymph nodes are situated in the retropharyngeal space, in the inter#al bet)een the pharyngeal )all and the pre#ertebral fascia. They recei#e lymph from the nasal part of the pharyn(, the auditory tube, and the upper part of the cer#ical #ertebral column. The efferent lymph #essels drain into the deep cer#ical lymph nodes. The laryngeal lymph nodes are situated in front of the laryn( on the cricothyroid ligament. ,ne or t)o small nodes may be found in front of the thyrohyoid membrane. They recei#e lymph from ad'acent structures, and their efferent #essels drain into the deep cer#ical lymph nodes. The tracheal lymph nodes are situated lateral to the trachea (paratracheal nodes) and in front of the trachea (pretracheal nodes). They recei#e lymph from neighboring structures, including the thyroid from neighboring structures, including the thyroid gland. The efferent lymph #essels drain into the deep cer#ical lymph nodes. Deep Cervical Lymph Nodes The deep cer#ical lymph nodes from a chain along the course of the internal 'ugular #ein, from the skull to the root of the neck. They are embedded in the fascia of the carotid sheath and the turcia ad#entitia of the internal 'ugular #ein* the ma'ority lie on the anterolateral aspect of the

internal 'ugular #ein. T)o of the nodes are often referred to clinically and are called the 'ugulodigastric node and the 'ugulo+omohyoid node. The 'ugulodigastric node lies 'ust belo) the posterior belly of the digastric muscle and is placed 'ust belo) and behind the angle of the mandible. -t is chiefly concerned )ith the lymph drainage of the tonsil and the tongue. The 'ugulo+omohyoid node is related to the intermediate tendon of the omohyoid muscle and is associated mainly )ith the lymph drainage of the tongue. The deep cer#ical lymph nodes recei#e lymph from neighboring structures and from all the other regional lymph nodes in the head and neck. The efferent lymph #essels 'oin to form the 'ugular lymph trunk. This #essel drains into the thoracic duct or the right lymph duct. .lternati#ely, it may drain into the subcla#ian lymph trunk or independently into the brachiocephalic #ein.