Lymphatic Drainage Of Head And Neck - JU Medicine

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Lymphatic drainage of head andneckEdited by: Batool B.

Lymph nodes of face and scalpFive groups of lymph nodesNotice how they’rearound the parotidOrdered anterior to posterior:1- Submental nodes2- Submandibular nodes(Post auricular)3- Pre-auricular/ parotid nodes4- Mastoid/ Postauricular nodes5- Occipital nodesThey form aring aroundthe base of theheadThere’s no lymphaticdrainage above thelevel of this ring

You’re not going to be asked about the specific parts each group drains from but,try to know the outline of each one of them.Important in the clinical application questions like:What is the lymph node most likely to be infected if an infection existed at a certainpoint? And you have to remember the draining lymph node of that area.

Draining site sites of each lymph node: Extra info*Submental brings Drainage from: lower lip, lower teeth, tip of the tongue, lower gingiva,anterior part of the floor of the mouthSubmandibular: completes draining the lower lip, the upper lip, side of the nose, medialside of the eye, anterior part of the foreheadPre-auricular/ parotid: the rest of the cheek, the upper and lower eyelids, from theanterior part of the auricle, anterior half of the scalpPost-auricular/ mastoid: posterior part of the auricle, middle posterior part of thescalp, lateral part of the scalpOccipital: most posterior part of the scalp

Lymph nodes of the neckSuperficial groupDeep group*exist in the superficialfascia* Deep to the deepfascia

Superficial cervical nodesDr. Heba KalbounehThe superficial cervicalnodes *highlighted in green*are a collection oflymph nodes along theexternal jugular vein onthe superficial surface ofsternocleidomastoidSuperficial veins: lateral external jugular veins Anterior jugular vein (alongits course are somesuperficial cervical lymphnodesVertical alongsuperficial veins

Course of the anterior jugular vein:It starts with the submental veins, they form 2 anterior jugularveins, which run in a vertical direction in the superficialanterior part of the neck.Just above the supra sternal notch they communicate formingthe jugular arch, then they separate, each one going laterallyto pierce the deep fascia becoming deep to eventually draininto deeper veins.

Deep cervical nodesDr. Heba KalbounehDeep Cervical Lymphnodes are divided into 2groups:1- Median group:-Retropharyngeal, prelaryngeal,pretracheal and paratracheal2- Lateral group: At the side of theneckrelated to the internal jugular vein:- Upper & lower deep cervical nodes

Dr. Heba KalbounehMedian group of deep cervicallymph nodes (deep)They’re named according to therelated structuresSupra hyoid lymph nodesLocated anterior to the larynxPrelaryngeal lymph nodesLocated anterior to the tracheaPretracheal andparatracheal lymphnodesAt the sides of trachea

Pretracheal layer posterior to the pharynx is calledBuccopharyngeal fasciaThyroidglandTracheaAnteriorPretracheal layerEsophagusIn between thepre-trachealand prevertebrallayers of deepfasciaAnother lymph node located deep in the midline posteriorlycalled retropharyngeal lymph nodesDr. Heba KalbounehPosterior

Lateral group of deep cervicallymph nodesAt side of neck along internaljugular veinDr. Heba KalbounehDeep cervical nodes arePart of the contents of thecarotid sheathThey’re divided into twogroup: upper and lower

Deep lateral cervicalnodes divided into two groupsThe intermediatetendon of theomohyoidmuscle dividesthe deep cervicallymph nodes intoupper andlower groupsRemember theomohyoid muscle(one of the infrahyoids), theintermediate tendonof it passes anterior tothe internal jugularvein , dividing thelateral deep lymphnodes.Dr. Heba Kalbouneh

Deep cervical nodes There are many lymph nodesbut these are the mostimportant clinically.Jugulo-digastric Node iswhere posterior belly ofdigastric crosses internaljugular veinJugulo-omohyoid nodeis at or just inferior tothe intermediate tendonof omohyoidDr. Heba Kalbouneh

Two important nodes in the deepcervical group1 – Jugulo-digastric nodeThis large node is whereposterior belly of digastriccrosses the internal jugular veinand receives lymphatic drainagefrom the tonsils and tongueEnlarged jugulodigastriclymph nodes are commonlyfound in tonsillitis2 - Jugulo-omohyoid nodeit is at or just inferior to theInfectionsintermediate tendon of omohyoid(painful) andmalignancy (nonpainful) causeThis node receives lymphaticswelling of lymphdrainage from the tonguenodes.Dr. Heba KalbounehDeep cervical nodes along Internaljugular vein

Dr. Heba Kalbouneh

Fate of lymph drainage of head & neckVenousangleVenous angle is formed by the union of theinternal jugular vein and the subclavian vein.We mentioned before the thoracic duct thatbrings lymphatic drainage from the lower part ofthe body. It has to pierce the diaphragm to interthe thorax and drain back into the venous blood.Where exactly?At the venous angleThe thoracic duct (other name: left lymphaticduct) pierces the diaphragm to drain into the leftvenous angle.Dr. Heba Kalbouneh

Drainage from the head and neck:All the lymphatic drainage of the head (the ring) will go into the upper deep cervicallymph nodesThe upper deep cervical drains into the lower deep cervical.Superficial cervical drain directly into the lower deep cervical.Then two lymphatic trunks will be formed, right and left jugular lymphatic trunks.On the right side: The subclavian trunk (drainage of the upper limb) unites with theright jugular trunk to form a duct called the right lymphatic duct (drains: right side ofhead, right side of the neck, right side of the thorax and the upper limb) which drainsinto the right venous angleThe rest of the body is eventually drained by the thoracic duct (left lymphatic duct)On the left side, same scenario, left jugular trunk with left subclavian drain directlyinto the left lymphatic duct which drains into the left venous angle.

Notice this image tounderstand further.

Root of thezygomaticarch,anterior tothe auricleAnterior in thetemple area.Pulse pointsWhere to takearterial pulses in thehead and neckEasiest to feelDr. Heba KalbounehFacial artery, as it crossesthe mandible, anterior tothe masseter muscleAsk patient to clench histeeth .

To check carotid pulsePlace your index and middlefingers on the neck to the side oflarynx (in carotid triangle), underthe angle of the mandibleWe can’t say it’s common orinternal or external hereDr. Heba Kalbouneh

Contents of the posteriortriangle5 Veins:1. External jugular vein2. Anterior jugular vein3. Transverse cervical vein4. Suprascapular vein5. Subclavian veinDr. Heba Kalbouneh4 Arteries:1. Occipital artery2. Subclavian artery (3rd part)3. Transverse cervical artery4. Suprascapular artery3 Nerves1. Brachial plexus (trunks)2. Spinal Accessory nerve3. Branches of cervical plexus1 MuscleInferior belly of omohyoid

Spinal accessory nerveSpinal accessory nerve is embedded in theinvesting layer of deep fascia (Whichforms the roof of the posterior triangle),stretched between two muscles (SCM, andtrapezius)The accessory nerve after supplyingtrapezius will run inside the two layers ofinvesting layer of deep fasciaThe relatively superficial location of thespinal accessory nerve as it crosses theposterior cervical triangle makes itsusceptible to injuryIf we have blunt trauma, since the nerveis stretched between two contractingmuscle, it’ll be damaged.Sharp object, whatever the state of thenerve (taut, relaxed) would cause injuryFlaccid nerve blunt trauma nervemay escape injuryDr. Heba KalbounehLesser occipital nerveGreat auricular nerveTransversecervical nerveTrunks ofbrachialplexusSupraclavicular nerves

Why do we have theomohyoid here?To under stand this, see nextslide brieflyIn order for the external jugularvein to become deep it has topierce the investing layer of deepfascia to drain into the subclavian.The opening of the external jugularis located inside this tense sheath.The tension of the sheath betweentrapezius and SCM, would causeclosure of this opening.Omohyoid (embedded into thisfascia) stretches this sheathdownward when contracted tokeep this opening open, to preventimpairment of this venousdrainage.Inferior belly of omohyoidDr. Heba Kalbouneh

Structures piercingthe roof of posteriortriangle (investinglayer of deep fascia)

Dr. Heba KalbounehHow to outline the anterior andposterior triangles of the neck

Estimating the position of the middle meningeal arteryDr. Heba Kalbouneh

Major featuresof the face

Drainage from the head and neck: All the lymphatic drainage of the head (the ring) will go into the upper deep cervical lymph nodes The upper deep cervical drains into the lower deep cervical. Superficial cervical drain directly into the lower deep cervical. Then two lymphatic trunks will be formed, right and left jugular lymphatic trunks.

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