Lymphatic Drainage of the Head and Neck.pdf

Lymphatic Drainage of the Head and Neck Dr. Jessa Mayet A. Sumatra-Mabalot Lymphatic System  Lymphatic or lymphoid system consists of: Fluid (lymph) Vessels that transport lymph A number of structures and organs containing lymphatic tissue Lymphatic System Interstitial fluid vs ly...

Lymphatic Drainage of the Head and Neck Dr. Jessa Mayet A. Sumatra-Mabalot Lymphatic System  Lymphatic or lymphoid system consists of: Fluid (lymph) Vessels that transport lymph A number of structures and organs containing lymphatic tissue Lymphatic System Interstitial fluid vs lymph Interstitial fluid- found between  cells Lymph- located within lymphatic vessels and lymphatic tissue Lymphatic Tissue Is a specialized form of reticular connective tissue that contains lymphocytes Agranular white blood cells (B & T Lymphocytes) e.g thymus, lymph nodes Lymphatic System Functions Drain excess interstitial fluid Transports dietary lipids Carries out immune responses Lymphatic Vessels  Begins as lymphatic capillaries which are located in the spaces between cells and unite to form lymphatic vessels that resemble small veins in structure but have thinner walls and more valves Lymphatic Vessels Lie in the subcutaneous tissue and generally follow the same route as veins Lymphatic vessels of the viscera generally follow arteries Avascular tissues ( cartilage, epidermis, cornea of the eye), portions of the spleen and red bone marrow lack lymphatic capillaries Lymphatic Capillaries Greater permeability and larger in diameter than blood capillaries can absorb large molecules such as proteins and lipids  One-way structure Lymph Trunks and Ducts capillaries— vessels— nodes— trunks—ducts—venous system Lymph trunks Formed by the unity of efferent lymphatic vessels from lymph nodes Lymph ducts Formed by the unity of lymphatic trunks Lymphatic Drainage of  the Head and Neck Lymphatic Vessels of the Head and Neck Can be divided into 2 major groups: superficial and deep Superficial vessels Drain lymph from the scalp, face, and neck into the superficial ring of lymph nodes at the junction of the head and neck Lymphatic Vessels of the Head and Neck Deep vessels  Arise from the deep cervical lymph nodes Converge to form: Left jugular lymphatic trunk Combines with the thoracic duct at the root of the neck Empties into the venous system via the left brachiocephalic vein Right jugular lymphatic trunk Forms the right lymphatic duct at the root of the neck Empties into the venous system via the right brachiocephalic vein  Right Lymphatic Duct Thoracic Duct Lymph Nodes Can be divided into 2 groups: Superficial lymph  nodes Deep lymph nodes Lymph Nodes Superficial Lymph Nodes Receive lymph from the scalp, face and neck Arranged in a ring shape Extends underneath the chin to the posterior aspect of the head Ultimately drain into the deep lymph nodes Lymph Nodes Superficial Lymph Nodes  Submandibular Facial Occipital Superficial cervical Mastoid/ post-auricular Pre-auricular Parotid Submental Occipital Lymph Nodes  Usually between 1-3 occipital lymph nodes Located in the back of the head at the lateral border of the trapezius muscle Collect lymph at the occipital area of the scalp Mastoid Lymph Nodes  Also called as post-auricular lymph nodes Located posterior to the ear Lie on the insertion of the sternocleidomastoid muscle into the mastoid process Collect lymph from the posterior neck, upper ear, and the back of the EAM Pre-Auricular Lymph Nodes  Located anterior to the auricle Collect lymph from superficial areas of the face and temporal region Parotid Lymph Nodes Located superficial to the parotid gland Collect lymph from the  nose, nasal cavity, EAM, TM, and the lateral borders of the orbit Submental Lymph Nodes Located superficial to the mylohyoid muscle Collect lymph from the central lower lip, floor of the mouth and apex of the tongue  Inferior view of the chin Submandibular Lymph Nodes Located below the mandible in the submandibular (digastric) triangle  Collect lymph from the cheeks, lateral aspect of the nose, upper lip, lateral parts of the lower lip, gums, and the anterior tongue Also receive lymph from facial and submental lymph nodes Facial Lymph Nodes Comprises the maxillary,/infraorbital, buccinator, and supramandibular lymph nodes Collect lymph from the nose, cheek, eyelids and conjunctiva  Superficial Cervical Lymph Nodes Can be divided into Superficial anterior cervical nodes Lie close to the anterior jugular vein and collect lymph from the anterior surface of the neck Posterior lateral superficial cervical lymph nodes Lie close to the external jugular vein and collect lymph from the superficial surfaces of  the neck Other Lymph Nodes (Regional) Retropharyngeal Nodes Lie behind the pharynx and in front of the vertebral column Receive lymph from the nasal pharynx, auditory tube, and vertebral column Laryngeal Nodes  Lie in front of the larynx Receive lymph from the larynx Tracheal (Paratracheal) Nodes Lie alongside the trachea Receive lymph from  neighboring structures including the thyroid Deep Lymph Nodes Deep Cervical Lymph Nodes Receive all of the lymph from the head and neck via the superficial LN Organized into a vertical chain located close to the internal jugular vein Its efferent vessels converge to form the jugular lymphatic trunks Deep Cervical Lymph Nodes Can be divided into superior and inferior deep cervical lymph nodes Include the prelaryngeal, pretracheal, paratracheal, retropharyngeal, infrahyoid, jugulodigastric (tonsilar), juguloomohyoid and supraclavicular nodes Jugulodigastric Lymph Nodes Deep Cervical Lymph Nodes Largest lymph node in the neck  Located below and behind the angle of the jaw, is mainly concerned with drainage of the tonsil and the tongue Juguloomohyoid Lymph Nodes Deep Cervical Lymph Nodes situated close to the omohyoid muscle, is mainly associated with drainage of the tongue. Lymph Node Levels of the Neck Lymph Node Levels of the Neck Lymph Node Levels of the Neck Ia - Submental Group  Contains the submental nodal group Borders: Symphysis menti superiorly Hyoid bone inferiorly Platysma muscle anteriorly Mylohyoid muscle posteriorly Anterior belly of the digastric laterally Lymph Node Levels of the Neck Ia - Submental Group  Drains the skin of the chin, mid-lower lip, anterior portion of the oral tongue, and the floor of the mouth Lymph Node Levels of the Neck Ib - Submandibular Group Contains the submandibular nodal group Borders: Mylohyoid muscle superiorly  Hyoid bone inferiorly Symphysis menti anteriorly Submandibular gland posterior edge posteriorly Digastric medially Lymph Node Levels of the Neck Ib - Submandibular Group Drain the efferent lymphatics from level Ia, lower nasal cavity, soft and hard palates and maxillary and  mandibular alveolar ridges Also drain the skin and mucosa of the cheek, upper and lower lips, floor of the mouth and anterior oral tongue Lymph Node Levels of the Neck Ib - Submandibular Group If swollen, may indicate infection of the drained structures  Associated with malignancies of oral cavity, anterior nasal cavity, soft tissues of mid face, and submandibular gland Lymph Node Levels of the Neck II - Upper Jugular Group Represents the beginning of the jugular chain Contains the upper jugular nodal group Borders: Insertion of the posterior belly of the digastric to the mastoid process superiorly Hyoid bone (caudal border) inferiorly  Submandibular gland anteriorly SCM (posterior edge) posteriorly SCM (medial surface) laterally ICA and scalenus muscle medially Lymph Node Levels of the Neck II - Upper Jugular Group Drains the efferent lymphatics of the face, parotid, level Ia & Ib, and retropharyngeal nodes Receives direct drainage from the nasal cavity, the entire pharyngeal axis, larynx, EAM, middle ear, sublingual and submandibular glands Lymph Node Levels of the Neck II - Upper Jugular Group Often contain metastatic deposits from malignancies of the nasal and oral cavities, nasopharynx, oropharynx, hypopharynx, larynx, and major salivary glands Most commonly involved nodal level Lymph Node Levels of the Neck III - Middle Jugular Group Located adjacent to the middle 3rd of internal jugular  vein Borders: Hyoid bone (caudal border) superiorly Cricoid cartilage (caudal edge) inferiorly Anterior edge of SCM anteriorly Posterior border of SCM posteriorly Medial Surface of SCM laterally ICA and Scalenus muscle medially Lymph Node Levels of the Neck III - Middle Jugular Group Drains lymph from level II & V, and partially form the retropharyngeal, pretrachea and  recurrent laryngeal nodes Receives direct drainage from the base of the tongue, tonsils, larynx, hypopharynx, and thyroid often assoc. with metastatic deposits from the oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx Lymph Node Levels of the Neck IV- Lower Jugular Group Located adjacent to the inferior 3rd of internal jugular vein Borders: Hyoid bone (caudal border) superiorly Sternoclavicular joint inferiorly  Anterior edge of SCM anteriorly Posterior border of SCM posteriorly Medial Surface of SCM laterally Medial edge of the common carotid artery, thyroid, scalenus muscle and SCM medially Lymph Node Levels of the Neck IV - Lower Jugular Group Drain lymphatics from levels III & V, partially retropharyngeal, pretracheal, and recurrent laryngeal nodes Receives direct drainage from the larynx, hypopharynx, and thyroid gland Often contain metastatic deposits from the hypopharynx, larynx, thyroid,  cervical esophagus, and rarely anterior oral cavity Lymph Node Levels of the Neck V- Posterior Triangle Group Contained within the posterior triangle Situated posterior to the SCM Borders: Hyoid bone (superior edge) superiorly Posterior margin of SCM anteriorly anterior border of trapezius posteriorly platysma laterally Levator scapulae and scalenus muscle medially Lymph Node Levels of the Neck V- Posterior Triangle Group Drain the lymphatics from the occipital, retro-auricular, occipital, and parietal scalp nodes Receive direct drainage from the skin of the lateral and posterior neck and shoulder, nasopharynx, oropharynx, and thyroid Lymph Node Levels of the Neck VI- Anterior Compartment Group VI a  Drains the integuments of the lower face and the anterior neck VI b Drains the lymphatics from the anterior floor of the mouth, tip of the oral tongue, lower lip, thyroid, glottic and supraglottic larynx, hypopharynx, and cervical esophagus