Lymph Nodes of the Head
The main clusters of lymphoid tissue on the head are concentrated around major salivary glands, along blood vessels, and within fascial spaces.
- Deep parotid nodes (nodi parotidei profundi). Numbering 3 to 10, they lie along the course of the superficial temporal artery. Depending on their topography relative to the parotid gland, they are classified as preauricular, infraauricular, and intraglandular nodes lying directly within the parenchyma.
- Facial nodes (nodi lymphoidei faciales). Located along the course of the facial artery. These include buccinator, nasolabial, malar, and mandibular nodes.
- Submandibular nodes (nodi lymphoidei submandibulares). Include 6–10 nodes located in the submandibular triangle along the inferior border of the mandible. Some may lie within the substance of the submandibular gland itself.
- Submental nodes (nodi lymphoidei submentales). Comprise 2–8 nodes lying on the anterior surface of the mylohyoid muscles, just superior to the body of the hyoid bone.
Cervical Lymph Nodes
Cervical nodes are classified by topographic triangles and depth into superficial and deep groups.
- Anterior cervical nodes (nodi lymphoidei cervicales anteriores). Superficial nodes accompany the anterior jugular vein inferior to the hyoid bone. Deep nodes surround the visceral neck structures: these include prelaryngeal, thyroid, as well as pretracheal and paratracheal nodes (the latter continuous with the tracheobronchial chain in the thorax).
- Lateral cervical nodes (nodi lymphoidei cervicales laterales). The superficial group (4–5 nodes) accompanies the external jugular vein. Deep nodes (10–15 nodes) run along the internal jugular vein and are divided into superior and inferior groups. Key landmarks include the jugulodigastric node (nodus jugulodigastricus) near the mandibular angle and the juguloomohyoid node (nodus juguloomohyoideus), located posterior to the intermediate tendon of the omohyoid muscle.
- Supraclavicular nodes (nodi supraclaviculares). Located in the omoclavicular triangle along the subclavian vein.
- Accessory nodes (nodi accessorii). Follow the accessory nerve within the occipital triangle.
- Retropharyngeal nodes (nodi retropharyngeales). Fixed on the posterolateral wall of the pharynx.
Drainage Pathways: Superficial Vessels
Superficial lymphatic vessels originate from the skin and form two main groups.
The posterior group collects lymph from the occipital, posterior parietal, and temporal regions, as well as the posterior surface of the auricle. Drainage leads to the occipital and mastoid (retroauricular) nodes, from which efferent vessels course to the deep cervical and superficial parotid nodes.
The anterior group drains the skin of the forehead, external nose, lateral eyelids, and anterior surface of the auricle. Lymph flows into superficial and then deep parotid nodes, continuing to the deep lateral cervical nodes. Note: Lymph from the tympanic membrane and external acoustic meatus also drains to the parotid nodes.
From the lips, cheeks, and medial eyelids, fluid flows to the submandibular nodes. The only exceptions are the center of the chin and the medial part of the lower lip, from which vessels drain directly to the submental nodes.
Drainage Pathways: Deep Vessels and Tongue
Deep vessels drain mucosal membranes, bones, muscles, and deep glands.
- Lymph from the hard and soft palate, nasal cavity, pharynx, middle ear, and lacrimal gland travels to the retropharyngeal and deep parotid nodes.
- From the teeth, gingiva, conjunctiva, and most salivary glands, lymph converges on the submandibular nodes before passing to the deep cervical chain.
Lymphatic drainage of the tongue exhibits strict regionality. Vessels from the body of the tongue deliver lymph to the deep cervical, submandibular, and retropharyngeal nodes. In contrast, drainage from the apex of the tongue goes exclusively to the submental lymph nodes.