Deep Lymphatics

The lymph nodes of the head and neck are divided into two seperate groups. They are :

  1. the circular chain around the base of the skull
  2. the deep and superificial cervical chains - deep around the IJV, and superficial around the afore mentioned EJV and AJV.

The circular chain of lymph nodes consists of seven individual and identifiable groups :

  1. Occipital - located around the occipital artery, drains the posterior part of scalp and adjacent region of neck.
  2. Retro-Auricular - located on mastoid process, drains external acoustic meatus, back of the auricle, and adjacent scalp.
  3. Superficial Parotid - located in front of the tragus, drains external acoustic meatus, front of auricle, and adjacent scalp.
  4. Deep Parotid - located deep to the parotid fascia and within the gland, drains anterior half of scalp, infratemporal region, orbit, lateral part of eyelids, upper molar teeth, external acoustic meatus, and parotid gland.
  5. Retropharyngeal - located between pharynx and the atlas, drains the upper part of the pharynx and related structures.
  6. Submandibular - located between the submandibular gland and the mandible, drains the anterior nasal cavities, tongue, teeth, gums, submandibular and sublingual glands, and all face except lateral part of eyelids and medial part of lower lip and chin.
  7. Submental - located behind the chin and on mylohyoid, drains the tip of the tongue, floor of the mouth, and the lower lip and chin.

Efferent vessels from all these groups, except the superficial parotid lymph nodes, pass to the deep cervical lymph chain. The superficial parotid group pass to the superficial cervical lymph nodes (which in turn drain into the deep cervical chain).

The deep cervical lymph chain lies around the IJV. The upper part of the chain is extended medially towards the retropharyngeal group of nodes. The lower part of the chain is extended laterally above the clavicle. Other named nodes of the chain are :

  • Jugulodigastric Node - located behind the angle of the mandible above the posterior belly of digastric, drains the tonsils and lateral part of the tongue.
  • Jugulo-Omohyoid Node - located in the angle between the IJV and superior belly of omohyoid, drains the tongue via the submental and submandibular nodes.
  • Para- and Pretracheal Nodes - located along the inferior thyroid vessels, drains the trachea and thyroid gland. Efferent vessels from these nodes can drain to the tracheobronchial nodes in the mediastinum.

This deep cervical lymph chain is respomsible for the drainage of most of the circular chain of nodes, and receives direct efferents from the salivary and thyroid glands, the tongue, the tonsil, the nose, the pharynx, and the larynx. All these vessels join together to form the juguluar lymph trunk. This vessel drains into either the thoracic duct on the left, the right lymph duct on the right, or independantly drain into either the internal jugular, subclavian, or brachiocephalic veins.