Lymph nodes of head & neck

Superficial Cervical lymph nodes

Deep Cervical Nodes

Innermost (waldeyer’s)or tonsillar ring

Cervical lymph nodes• Superficial Cervical lymph nodes:• The lymph nodes of the head and neck are arranged as a

regional collar that extends from below the chin to the back of the head.

• Deep Cervical Nodes:• The deep cervical nodes form a vertical chain along the course

of the internal jugular vein within the carotid sheath. They receive lymph from all the groups of regional nodes. The jugulodigastric node, which is located below and behind the angle of the jaw, is mainly concerned with drainage of the tonsil and the tongue. The jugulo-omohyoid node, which is situated close to the omohyoid muscle, is mainly associated with drainage of the tongue.

• The efferent lymph vessels from the deep cervical lymph nodes join to form the jugular trunk, which drains into the thoracic duct or the right lymphatic duct.

Superficial group

• Superficial group is situated around the junction of head & neck.

• These drain superficial structures of head & some deep parts. Most of efferents lymph vessels pass to deep.

Deep group

• Deep group occurs in a chain & are arranged along internal jugular vein from digastic to root of neck within the carotid sheath.

• These are divided into upper & lower groups by omohyoid. They receive lymph from all the groups of regional nodes These also receive lymph from behind_pharynx : retropharyngeal nodes.

Upper deep group

• Is situated in angle between the lower border of mandible & SCM itself.

• These are related to IJV & posterior belly of digastric_jugulodigastric nodes.(one of these is called Tonsillar lymph node)

Lower deep cervical

Upper deep cervical

Lower border of mandible

Clavicle

Sternucleidomastoid

Lower deep group• Is found in posterior triangle of neck in angle

between SCM & clavicle lying partially deep to SCM.

• These are called called jugulo-omohyoid or supraclavicular nodes. These receive lymph from upper cervical group of breast & enter in structure in thorax & abdomen. The efferent from this form jugular trunk leading to thoracic duct/right lymphatic duct.

• Upper most group:– Occipital, – postauricular, – parotid, – buccal.

• 2nd group:– Submental, – submandibular, – upper deep cervical(jugular) lymph nodes

• 3rd group:– Infrahyoid(superficial cervical), – pararacheal(anterior cervical) lymph nodes

• 4th group:– Lower deep cervical lymph nodes(at the apex of inverted

triangle)

The occipital lymph nodes

• Lie on upper end of trapezius & on fascia at apex of posterior triangle, These are situated over the occipital bone on the back of the skull.

• They receive lymph from the back of the scalp & back of neck. Drain to upper deep cervical group.

The postauricular(retromandibular/ mastoid) lymph nodes

• Lie on superior end of SCM,posterior to auricle. These lie behind the ear over the mastoid process.

• They receive lymph from the scalp above the ear, the auricle, and the external auditory meatus. Drain to upper deep cervical lymph nodes.

The Parotid lymph nodes

• Scattered through parotid gland. Drain auricle, external auditory meatus, from the scalp above the parotid gland, deep group drain temporal & infratemporal fossa, the middle ear, auditory tube, upper molar teeth, & gums.

• Efferents drain to lower pole of parotid gland to deep upper cervical lymph nodes on external jugular vein.

The buccal lymph nodes

• Lie on buccinator. One or two nodes lie in the cheek over the buccinator muscle. They drain lymph that ultimately passes into the submandibular nodes

The submental lymph nodes

• These lie in the submental triangle just below the chin on fascia covering myelohyoid between anterior bellies of digastric. These drain lymph from a wedge shaped zone which include incisor teeth & gums & anterior part of floor of mouth. Drain to deep cervical lymph nodes.

The submandibular lymph nodes

• Lie along submandibular gland mainly under cover of mandible just below the lower margin of the jaw.Receive lymph vessels from area below the line joining the medial angle of eye & angle of mandible. Deeper lymph vessels drain submandibular & submenatal, the side of tongue, gums, part of palate, anterior part of walls of nasal cavity, the frontal, maxillary, and ethmoid sinuses.

• Drain to submandibular lymph nodes to deep cervical lymph nodes.

The infrahyoid lymph nodes

• Lying in relation to larynx on thyrohyoid & cricothyroid membrane.

• Drain structures in the middle of neck.

The paratracheal lymph nodes

• Lying between trachea & oesophagus.

• Drain middle of neck to upper & lower deep cervical lymph nodes.

The retropharyngeal lymph nodes

• Lie on fascia of posterior wall of upper pharynx at level of mastoid process.

• Drain oral & nasal parts of pharynx, palate, nose, PNS, auditory tube & middle ear cavity.

Waldeyer's ring

• Waldeyer's ring is a circumpharyngeal ring of mucosa-associated lymphoid tissue which surrounds the openings into the digestive and respiratory tracts.

• It is made up – anteroinferiorly by the lingual tonsil,

– laterally by the palatine and tubal tonsils,– posterosuperiorly by the nasopharyngeal tonsil – smaller collections of lymphoid tissue in the inter-

tonsillar intervals.

Clinical Significance of the Cervical Lymph Nodes

• Knowledge of the lymph drainage of an organ or region is of great clinical importance.

• Examination of a patient may reveal an enlarged lymph node.

• For example, an enlarged submandibular node can be caused by a pathologic condition in the scalp, the face, the maxillary sinus, or the tongue. An infected tooth of the upper or lower jaw may be responsible. Often a physician has to search systematically the various areas known to drain into a node to discover the cause.

Examination of the Deep Cervical Lymph Nodes

• Lymph nodes in the neck should be examined from behind the patient.

• The examination is made easier by asking the patient to flex the neck slightly to reduce the tension of the muscles. The groups of nodes should be examined in a definite order to avoid omitting any.After the identification of enlarged lymph nodes, possible sites of infection or neoplastic growth should be examined, including the face, scalp, tongue, mouth, tonsil, and pharynx.

Carcinoma Metastases in the Deep Cervical Lymph Node

• In the head and neck, all the lymph ultimately drains into the deep cervical group of nodes. Secondary carcinomatous deposits in these nodes are common. The primary growth may be easy to find. e.g. larynx, the pharynx, the cervical part of the esophagus, and the external auditory meatus, the bronchi, breast, and stomach. In these cases, the secondary growth has spread far beyond the local lymph nodes.

• When cervical metastases occur, the surgeon usually decides to perform a block dissection of the cervical nodes. This procedure involves the removal en bloc of the internal jugular vein, the fascia, the lymph nodes, and the submandibular salivary gland. The aim of the operation is removal of all the lymph tissues on the affected side of the neck. The carotid arteries and the vagus nerve are carefully preserved.