LYMPHATIC DRAINAGE

OF HEAD & NECK

By
Dr. Htar Htar Aung
School of Medicine
 Objectives
At the end of this plenary, the students should
be able to
1. describe the components of the lymphatic
system.
2. describe the regional lymph nodes of head
and neck.
3. describe the deep cervical lymph nodes.
4. apply the clinical importance of lymphatic
drainage
Lymphatic system
- provides for the
drainage of surplus
tissue fluid and
leaked plasma
proteins to the
bloodstream
- is also for the
removal of debris
from cellular
- decomposition
provides a and
infection.
(relatively)
predictable route
for
the spread of
certain
types of cancerous
 COMPONENTS
Lymph
- tissue fluid (clear water)
- is similar in composition to plasma.
Lymphatic plexus
- network of lymphatic capillaries
Lymphatic Vessels (lymphatics)
- a nearly bodywide network of thin-walled vessels
- occur almost everywhere blood capillaries are
found except
teeth, bone, bone marrow and the central
nervous system.
Lymph nodes
- small masses of lymphatic tissue
Lymphoid organs
- thymus, red bone marrow, spleen, tonsils,
 Lymph Drainage of the Head
and Neck

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
and
- a deep vertical
terminal group
that is embedded in
the carotid sheath in
the neck
1.Regional nodes
From the nearby
region & then drain
to the Deep cervical
nodes
2.Deep cervical nodes
receive all the
lymphatics from
H&N
-from deep cervical
nodes
to Jugular trunk
Left. Thoracic
duct
Right.-
Regional nodes
L .nodes encircling the
junction between
H.&N.
Occipital
receive lymph from the
back of the scalp
Mastoid
receive from the scalp
above the ear, the
auricle, and the
external auditory
meatus.
Preauricular(Parotid)
receive lymph from the
scalp above the
parotid gland, the
Sub mandibular
-superficial to the
submandibular salivary
gland just below the lower
margin of the jaw
-receive from the front of
the scalp; the nose; the
cheek; the upper lip and
the lower lip (except the
central part); the frontal,
maxillary, and ethmoid
sinuses; the upper and
lower teeth (except the
lower incisors); the anterior
two thirds of the tongue
(except the tip); the floor of
the mouth and vestibule;
and the gums
Submental
Buccal(facial)
- lymph from the tip of the tongue, the floor of the anterior part of
the lie in thethe
mouth, cheek over the
buccinator
incisor teeth, muscle
the center part of the lower lip, and the skin over
Lymph nodes along
superficial veins
Anterior cervical
- along anterior
jugular vein
- receive lymph from
the skin and
superficial tissues of
Ant.jugular
the front of the neck External jugular

Superficial cervical
- along External
Jugular Vein
- drain lymph from the
skin over the angle of
Around the Viscerae
Retropharyngeal
lie behind the pharynx
and in
front of the vertebral
column.
receive lymph from the
nasal
pharynx, the auditory
tube, and
the vertebral column
Laryngeal
lie in front of the larynx.
receive lymph from the
larynx.
Tracheal
 Deep Cervical nodes
Location -along Internal
Jugular Vein in carotid
sheath
- receives the lymph Deep cervical
from all
groups from the
regional
nodes

-*Jugulo-digastric
Located below and
behind the
angle of mandible
drains from Tonsil &
tongue
 Deep Cervical nodes
-*Jugulo-omohoid
- posterior to
Internal Jugular Deep cervical
vein
- close to the
Omohyoid
- drains from
Tongue
-*Supra
clavicular
secondary eg.
From Ca.Breast &
Lymph nodes of Head &
Neck
 Clinical applications
Regional nodes can be palpated
when enlarged
Eg. Submandibular nodes in
pathology of
scalp, face, tongue, tooth or
maxillary
sinus

Palpation of submandibular lymph

nodes
Examination of the Deep Cervical Lymph
Nodes
- should be examined from behind the
patient.
- by asking the patient to flex the neck
slightly to reduce the tension of the
muscles.

Palpation of supraclavicular lymph

nodes
 Clinical applications
Enlargement of Retropharyngeal node can
cause Dysphagia
Deep cervical nodes
Secondary Carcinomatous deposits in this
group
Radical Neck Dissections
- aim to remove all tissue that bears lymph
nodes in one
piece
- Deep cervical lymph nodes and tissues around
them are
removed as completely as possible
- usually performed when cancer invades the
cervical
lymphatics
Thank You