Venous and lymphatic drainage of head seminar Dr. Abhishek Roy

1. 1
Venous
and
Lymphatic
Drainage of
Head &
Face
Abhishek Roy
Ist Yr PG
OMFS

2. 22
ContentsContents
• IntroductionIntroduction
• Venous systemVenous system
• Veins vs ArteriesVeins vs Arteries
• Veins of Head and FaceVeins of Head and Face
• Anatomical VariationsAnatomical Variations
• Introduction to LymphIntroduction to Lymph
• Lymphatic SystemLymphatic System
• Flow of LymphFlow of Lymph
• Classification of Lymph nodesClassification of Lymph nodes
• Lymph nodes of Head and NeckLymph nodes of Head and Neck
• Causes of Lymph node enlargementCauses of Lymph node enlargement
• ConclusionConclusion
• ReferencesReferences

3. 33
IntroductionIntroduction
•The venous system is a network of conduits i.e.The venous system is a network of conduits i.e.
veins which transport deoxygenated blood fromveins which transport deoxygenated blood from
tissues to the heart.tissues to the heart.
•Exceptions are the Pulmonary and UmbelicalExceptions are the Pulmonary and Umbelical
veins, both of which carry oxygenated blood toveins, both of which carry oxygenated blood to
the heart. Equally important ,they serve as majorthe heart. Equally important ,they serve as major
reservoirs of blood.reservoirs of blood.

4. 44

5. 55
Introduction(contd.)Introduction(contd.)
• About 84% of entire blood volume of body is inAbout 84% of entire blood volume of body is in
systemic circulation and 16% in heart and lungs.systemic circulation and 16% in heart and lungs.
• Of the 84 % in systemic circulation,64%is inOf the 84 % in systemic circulation,64%is in
veins,13%in arteries and 7% in systemicveins,13%in arteries and 7% in systemic
arterioles and capillaries.arterioles and capillaries.

6. 66
Functioning of VenousFunctioning of Venous
systemsystem
• The venous system in the
body returns deoxygenated
blood from all parts of the
body, including the organs,
to the right side of the
heart, and then on to the
lungs, to be oxygenated.
From the lungs, the
oxygenated blood passes
to the left part of the heart,
to be pumped to all the
tissues and organs of the
body.

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Types of VeinsTypes of Veins
 Superficial Veins are thoseSuperficial Veins are those whosewhose coursecourse isis closeclose toto thethe
surface of the body and have no corresponding arteries.surface of the body and have no corresponding arteries.
 Deep Veins are deeper in the body and have correspondingDeep Veins are deeper in the body and have corresponding
arteriesarteries
 Communicating veins (or perforator veins) are veins thatCommunicating veins (or perforator veins) are veins that
directly connect superficial veins to deep veins.directly connect superficial veins to deep veins.
 The pulmonary veins are a set of veins that deliver oxygenatedThe pulmonary veins are a set of veins that deliver oxygenated
blood from the lungs to the heartblood from the lungs to the heart
 Systemic Veins drain the tissues of the body and deliverSystemic Veins drain the tissues of the body and deliver
deoxygenated blood to the heart.deoxygenated blood to the heart.

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Superficial Veins of HandSuperficial Veins of Hand

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Blood VesselsBlood Vessels

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Valves of VeinsValves of Veins

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Histological ViewHistological View

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Embryology of VeinsEmbryology of Veins

13. 1313

14. 1414
Veins of Head and FaceVeins of Head and Face

15. 1515
Veins of head and faceVeins of head and face
• Supratrochlear veinSupratrochlear vein
• Supraorbital veinsSupraorbital veins
• Facial veinFacial vein
• Superficial temporal veinSuperficial temporal vein
• Pterygoid venous plexusPterygoid venous plexus
• Maxillary veinMaxillary vein
• Retromandibular veinRetromandibular vein
• Posterior auricular veinPosterior auricular vein
• Occipital veinOccipital vein

16. 1616
Supratrochlear VeinSupratrochlear Vein
•This starts on the
forehead . Veins from this form
a single trunk, descending near
the midline parallel to radix nasi
.
•The veins then diverge,
each joining supraorbital vein
near medial canthus to form
facial vein.

17. 1717
Supraorbital VeinSupraorbital Vein
ORIGINORIGIN::
Zygomatic process ofZygomatic process of
frontal bonefrontal bone
EMPTIESEMPTIES::
Angular VeinAngular Vein
DRAINS:
Eyebrows and
forehead

18. 1818
Anterior Facial VeinAnterior Facial Vein
 Is formed by the union of theIs formed by the union of the
supraorbital andsupraorbital and
supratrochlear veins to formsupratrochlear veins to form
the angular veinthe angular vein
 Communicate with theCommunicate with the
cavernous sinus through thecavernous sinus through the
ophthalmic vein via theophthalmic vein via the
supraorbital veinsupraorbital vein

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Anterior Facial VeinAnterior Facial Vein
• Runs downwards and backwardsRuns downwards and backwards
behind the facial artery to thebehind the facial artery to the
lower border of the mandiblelower border of the mandible
• To be joined by the anteriorTo be joined by the anterior
division of the retromandibulardivision of the retromandibular
veinvein
Joins the:
 Pterygoid plexus through deepPterygoid plexus through deep
facial veinfacial vein
 Cavernous sinus throughCavernous sinus through
superior ophthalmic veinsuperior ophthalmic vein

20. 2020
TributariesTributaries--
 Anterior facial vein receives a branch of deepAnterior facial vein receives a branch of deep facialfacial
vein from pterygoid venous plexus.vein from pterygoid venous plexus.
 Joined by superior and inferior palpebral, superiorJoined by superior and inferior palpebral, superior
and inferior labial, buccinator and masseteric veins.and inferior labial, buccinator and masseteric veins.
 Below mandible receives submental, palatine,Below mandible receives submental, palatine,
submaxillary, and vena comitans of hypoglossal nerve.submaxillary, and vena comitans of hypoglossal nerve.

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Dangerous Area of FaceDangerous Area of Face
The facial vein is devoid
of valves and rests directly on
the facial muscles.
Absence of deep fascia
The movement of facial
muscles might facilitate the
spread of septic emboli from the
infected area of upper lip and
lower part of the nose in
retrograde direction.
Cause thrombosis of
cavernous sinus with serious
complication.

22. 2222
Applied ImportanceApplied Importance
Facial veins have no valves and it connects to cavernousFacial veins have no valves and it connects to cavernous
sinus by two routes –sinus by two routes –
1. via ophthalmic vein or supraorbital vein1. via ophthalmic vein or supraorbital vein
2. via deep facial vein to pterygoid plexus2. via deep facial vein to pterygoid plexus
and hence to cavernous sinusand hence to cavernous sinus
Thus infective thrombosis of facial vein may extend toThus infective thrombosis of facial vein may extend to
intracranial venous sinusintracranial venous sinus

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Cavernous Sinus ThrombosisCavernous Sinus Thrombosis
• severe headachessevere headaches
• neck stiffnessneck stiffness
• altered consciousness levelsaltered consciousness levels
• epileptic fitsepileptic fits
• high grade feverhigh grade fever
• rigorsrigors
• headachesheadaches
• a reduced conscious levela reduced conscious level

24. 2424
Superficial temporal VeinSuperficial temporal Vein
•This begins in a widespread
network joined across the scalp.
•Frontal and Parietal branches
emerge which combine to form
trunk of vein above Zygomatic arch
•It crosses posterior root of zygoma
and enters the parotid gland to join
the maxillary vein, to form
retromandibular vein.
•Drains : side of scalp, temporalis
muscle and ear.

25. 2525
PTERYGOID VENOUS PLEXUSPTERYGOID VENOUS PLEXUS
LOCATIONLOCATION::
Partly b/w temporalis & lateralPartly b/w temporalis & lateral
pterygoid & partly b/w pterygoidspterygoid & partly b/w pterygoids
CONNECTSCONNECTS::
Deep facial vein withDeep facial vein with
cavernous sinus via.cavernous sinus via.
foramen ovale andforamen ovale and
foramen lacerumforamen lacerum
DRAINAGEDRAINAGE::
 Chiefly: Maxillary VeinChiefly: Maxillary Vein
 Retromandibular VeinRetromandibular Vein

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Applied ImportanceApplied Importance
•Applied importance :Applied importance :
- Needle track communications can also result in infection to- Needle track communications can also result in infection to
pterygoid plexus.pterygoid plexus.
- PSA block- PSA block hematoma , black eyehematoma , black eye
- serve as a media for spread of external infection to eye.- serve as a media for spread of external infection to eye.

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Maxillary veinMaxillary vein
Unites with superficialUnites with superficial
temporal to formtemporal to form
retromandibular veinretromandibular vein

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Retromandibular VeinRetromandibular Vein
 Formed by the union of maxillaryFormed by the union of maxillary
vein and superficial temporal vein.vein and superficial temporal vein.
 Leaving parotid gland divides intoLeaving parotid gland divides into
anterior branch and posterioranterior branch and posterior
branch.branch.
 Anterior branch joins facial veinAnterior branch joins facial vein
which drains into common facialwhich drains into common facial
vein to internal jugular veinvein to internal jugular vein
 Posterior branch joins posteriorPosterior branch joins posterior
auricular vein to form externalauricular vein to form external
jugular vein.jugular vein.

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Posterior auricular veinPosterior auricular vein
ORIGINORIGIN::
Parieto occipital plexus of veinsParieto occipital plexus of veins
DESCENDSDESCENDS::
Behind auricle,Behind auricle,
Joins posterior facial vein to formJoins posterior facial vein to form
external jugular veinexternal jugular vein
Applied importanceApplied importance : receives mastoid: receives mastoid
emissary veins from sigmoid sinus.emissary veins from sigmoid sinus.
Infection here can be dangerous orInfection here can be dangerous or
fatal from retrograde thrombosis offatal from retrograde thrombosis of
cerebellar and medullary veinscerebellar and medullary veins

30. 3030
Occipital veinOccipital vein
ORIGIN:ORIGIN:
•Posterior network inPosterior network in
scalpscalp
•Joins deep cervical &Joins deep cervical &
vertebral veinsvertebral veins
COURSE:COURSE:
•Follows occipital arteryFollows occipital artery
ENDS:ENDS:
•Internal Jugular veinInternal Jugular vein
•Sometimes joins posterior auricularSometimes joins posterior auricular
vein which joins EJVvein which joins EJV

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Anatomical VariationsAnatomical Variations
 The common facial vein does not exist. TheThe common facial vein does not exist. The
retromandibualr vein continues into the externalretromandibualr vein continues into the external
jugular vein, the facial vein opens into the internaljugular vein, the facial vein opens into the internal
jugular vein.jugular vein.
 The retromandibular vein opens into the internalThe retromandibular vein opens into the internal
jugular vein, the facial vein continues into thejugular vein, the facial vein continues into the
anterior jugular vein, and a common facial veinanterior jugular vein, and a common facial vein
again is absent.again is absent.

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Anatomical Variations(contd.)Anatomical Variations(contd.)
 The common facial vein loses its connection with theThe common facial vein loses its connection with the
internal jugular vein and empties instead into theinternal jugular vein and empties instead into the
external jugular veinexternal jugular vein
• Retromandibular vein continues into the externalRetromandibular vein continues into the external
jugular vein, facial vein continues into the anteriorjugular vein, facial vein continues into the anterior
jugular vein.jugular vein.

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Anatomical Variations(contd.)Anatomical Variations(contd.)
•In someIn some cadaverscadavers the followingthe following variationvariation waswas
observed, theobserved, the facial vein was found running downwardfacial vein was found running downward
& backwards at the anterior border of masseter& backwards at the anterior border of masseter,where,where
thethe submental vein united with the facial vein to form asubmental vein united with the facial vein to form a
common venous channelcommon venous channel..
•The common venous channel united with theThe common venous channel united with the
retromandibular vein at the angle of the mandible toretromandibular vein at the angle of the mandible to
form the common facial vein.form the common facial vein.
• Before this common facial vein joins the internalBefore this common facial vein joins the internal
jugular vein , a venous channel originating from thejugular vein , a venous channel originating from the
anterior jugular vein comes & joins the common facialanterior jugular vein comes & joins the common facial
vein &which then joins the internal jugular vein.vein &which then joins the internal jugular vein.
( j anat.soc.india,52(1),64-65 (2003))( j anat.soc.india,52(1),64-65 (2003))

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Lymphatic Drainage
of Head and Face

35. 3535
LymphLymph
DefinitionDefinition:: Transparent, slightly yellowish liquid of alkalineTransparent, slightly yellowish liquid of alkaline
reaction found in lymphatic vessels and derived from tissuereaction found in lymphatic vessels and derived from tissue
fluidfluid
Rate of lymph flowRate of lymph flow::
• About 100ml/hr lymph flows via. thoracic duct of a restingAbout 100ml/hr lymph flows via. thoracic duct of a resting
human.human.
• Approximately 20ml/hr flows into circulation.Approximately 20ml/hr flows into circulation.
• Total estimated lymph flow is about 120ml/hrTotal estimated lymph flow is about 120ml/hr

36. 3636
Lymphatic SystemLymphatic System
•The lymphatic system is a endotheliun – linedThe lymphatic system is a endotheliun – lined
network of blind ended capillaries found in nearlynetwork of blind ended capillaries found in nearly
all tissues, draining via collecting vessels into largeall tissues, draining via collecting vessels into large
vascular trunks that eventually empty into bloodvascular trunks that eventually empty into blood
circulatory system.circulatory system.
•The lymphatic system is a part of immune system .The lymphatic system is a part of immune system .

37. 3737
Lymphatic SystemLymphatic System
Consist of:
1)Lymphatic channels-
a) lymphatic capillaries
b) lymphatic vessels
2) Lymph
3 )Lymph nodes
4) Lymphoid organs and
tissues

38. 3838
Embryonic developmentEmbryonic development
Begins to develop by end of 5Begins to develop by end of 5thth
wk. IU lifewk. IU life
Develop from lymph sacs thatDevelop from lymph sacs that
arise from developing veins,arise from developing veins,
derived from mesoderm.derived from mesoderm.
6 primary lymph sacs formed6 primary lymph sacs formed
First lymph sacs to appear areFirst lymph sacs to appear are
paired jugular lymph sacs .paired jugular lymph sacs .

39. 3939
Capillary plexuses enlargeCapillary plexuses enlarge
Form lymphatic vesselsForm lymphatic vessels
Each jugular lymphEach jugular lymph
sac retains at leastsac retains at least
one connection withone connection with
its jugular veinits jugular vein
Left one developingLeft one developing
into superior portioninto superior portion
of thoracic duct.of thoracic duct.

40. 4040
88thth week of IUL - Retroperitoneal lymph sacs forms.week of IUL - Retroperitoneal lymph sacs forms.
99thth week of IUL cisterna chyli develops-lower part ofweek of IUL cisterna chyli develops-lower part of
thoracic duct develops from left jugular sac.thoracic duct develops from left jugular sac.
Later stages-lymph sacs are invaded byLater stages-lymph sacs are invaded by
lymphocytes.lymphocytes.
Transformed into group of lymph nodesTransformed into group of lymph nodes

41. 4141
FunctionsFunctions
•The lymphatic system has
three functions :
1. Fluid recovery
2. Immunity
3. Lipid absorption

42. 4242
Route of LymphRoute of Lymph

43. 4343
WALDEYER’S LYMPHATIC RINGWALDEYER’S LYMPHATIC RING
• Ringed arrangement of lymphoid tissue in theRinged arrangement of lymphoid tissue in the
pharynxpharynx
• Waldeyer's ring surrounds the naso- andWaldeyer's ring surrounds the naso- and
oropharynx, with some of its tonsillar tissueoropharynx, with some of its tonsillar tissue
located above and some below the soft palatelocated above and some below the soft palate
• Presence ofPresence of MALTMALT
• Aggregations are :Aggregations are :
 Pharyngeal tonsil - 1Pharyngeal tonsil - 1
 Tubal tonsils - 2Tubal tonsils - 2
 Palatine tonsils - 2Palatine tonsils - 2
 Lingual tonsil - 1Lingual tonsil - 1

44. 44
Classification by American Joint
Committee on Cancer and the American
Academy of Otolaryngology- Head and
Neck Surgery

45. 4545
Classification byClassification by American JointAmerican Joint
Committee on Cancer and the AmericanCommittee on Cancer and the American
Academy of OtolaryngologyAcademy of Otolaryngology- Head and- Head and
Neck SurgeryNeck Surgery

46. 4646
Level I - all nodes above hyoid bone, belowLevel I - all nodes above hyoid bone, below
mylohyoid muscle, and anterior to posterior edge ofmylohyoid muscle, and anterior to posterior edge of
submandibular glandsubmandibular gland
Level IA - all nodes between medial margins ofLevel IA - all nodes between medial margins of
anterior digastric muscles, above hyoid bone, belowanterior digastric muscles, above hyoid bone, below
mylohyoid musclemylohyoid muscle

47. 4747
Level IB - all nodes below mylohyoid muscle,Level IB - all nodes below mylohyoid muscle,
above hyoid bone, posterior and lateral toabove hyoid bone, posterior and lateral to
medial anterior digastric musclemedial anterior digastric muscle and anteriorand anterior
to submandibular glandto submandibular gland

48. 4848
Level II - all nodes below skull base at jugularLevel II - all nodes below skull base at jugular
fossa to hyoid bone, anterior to posterior edgefossa to hyoid bone, anterior to posterior edge
of sternocleidomastoid muscle and posterior toof sternocleidomastoid muscle and posterior to
submandibular glandsubmandibular gland

49. 4949
Level IIA - all nodes that lie posterior to internal jugular veinLevel IIA - all nodes that lie posterior to internal jugular vein
and are inseparableand are inseparable from vein or lie anterior, lateral or medialfrom vein or lie anterior, lateral or medial
to veinto vein
Level IIB - all nodes that lie posterior to internal jugular veinLevel IIB - all nodes that lie posterior to internal jugular vein
and have a fat plane separating nodes and veinand have a fat plane separating nodes and vein

50. 5050
Level III - all nodes between hyoid bone and cricoid cartilageLevel III - all nodes between hyoid bone and cricoid cartilage
arch and anterior to posterior sternocleidomastoid muscle, andarch and anterior to posterior sternocleidomastoid muscle, and
lateral to ICAlateral to ICA
Level IV - all nodes between cricoid cartilage arch and clavicle,Level IV - all nodes between cricoid cartilage arch and clavicle,
anterior to posterior sternocleidomastoid muscle and posteroanterior to posterior sternocleidomastoid muscle and postero
lateral to anterior scalene muscle and lateral to CCAlateral to anterior scalene muscle and lateral to CCA

51. 5151
Level V - all nodes from skullLevel V - all nodes from skull
base posterior down to posteriorbase posterior down to posterior
border of sternocleidomastoidborder of sternocleidomastoid
muscle to level of clavicle,muscle to level of clavicle,
anterior to trapezius muscleanterior to trapezius muscle

52. 5252
Level VA - all nodes between skull base and cricoid cartilageLevel VA - all nodes between skull base and cricoid cartilage
arch, behind posterior edge of sternocleidomastoid musclearch, behind posterior edge of sternocleidomastoid muscle
Level VB - all nodes between cricoid cartilage arch and clavicle,Level VB - all nodes between cricoid cartilage arch and clavicle,
behind sternocleidomastoid musclebehind sternocleidomastoid muscle

53. 5353
Level VI - all nodes inferior toLevel VI - all nodes inferior to
hyoid bone and above top ofhyoid bone and above top of
manubrium, between medialmanubrium, between medial
margins of bilateral CCA and ICAmargins of bilateral CCA and ICA
Level VII - all nodes behindLevel VII - all nodes behind
manubrium between medialmanubrium between medial
margins of CCA bilaterally,margins of CCA bilaterally,
extending inferiorly to level ofextending inferiorly to level of
innominate veininnominate vein

54. 5454

55. 5555
SUPERFICIAL NODESSUPERFICIAL NODES
•Sub-mental nodesSub-mental nodes
•Sub-mandibular nodesSub-mandibular nodes
•Buccal nodesBuccal nodes
•PreauricularPreauricular
•PostauricularPostauricular
•OccipitalOccipital
•Anterior cervicalAnterior cervical
•Superficial cervicalSuperficial cervical

56. 5656
b) The deep cervical nodes :b) The deep cervical nodes :
- The upper deep cervical ( jugulo - digastric group ): lie- The upper deep cervical ( jugulo - digastric group ): lie
along the upper part of internal jugular vein deep toalong the upper part of internal jugular vein deep to
sternocleidomastoid muscle.sternocleidomastoid muscle.
- The lower deep cervical ( jugulo- omohyoid group):- The lower deep cervical ( jugulo- omohyoid group):
arranged along the lower part of internal jugular vein.arranged along the lower part of internal jugular vein.
DEEP LYMPH NODESDEEP LYMPH NODES
•Prelaryngeal and PretrachealPrelaryngeal and Pretracheal
•ParatrachealParatracheal
•RetropharyngealRetropharyngeal

57. 5757
SUBMENTAL LYMPH NODESSUBMENTAL LYMPH NODES
•Lies b/w chin & hyoid bone & b/wLies b/w chin & hyoid bone & b/w
anterior bellies of digastric muscles inanterior bellies of digastric muscles in
submental triangles.submental triangles.
•Receives lymph from tip of tongue,Receives lymph from tip of tongue,
floor beneath tongue, lower incisors,floor beneath tongue, lower incisors,
central part of lower lip, and skin overcentral part of lower lip, and skin over
chinchin
•Drains into submandibular & deepDrains into submandibular & deep
cervical nodescervical nodes

58. 5858
SUBMANDIBULAR LYPMH NODESSUBMANDIBULAR LYPMH NODES
a) Superficial surface of submandibulara) Superficial surface of submandibular
salivary gland.salivary gland.
b) Beneath investing layer of deep cervicalb) Beneath investing layer of deep cervical
fascia.fascia.
• They are divided into anterior, middle, deepThey are divided into anterior, middle, deep
group.group.
•Anterior group found along submental veinAnterior group found along submental vein
close to chin.close to chin.
•Middle group situated around facial vein&Middle group situated around facial vein&
facial artery above submandibular salivaryfacial artery above submandibular salivary
gland.gland.
•Posterior group located behind facial vein.Posterior group located behind facial vein.

59. 5959
Receives lymph from:Receives lymph from:
•Front of scalp.Front of scalp.
•Anterior part of nasal cavity, palate & adjacentAnterior part of nasal cavity, palate & adjacent
cheek.cheek.
•Upper & lower lip except central part.Upper & lower lip except central part.
•Frontal, maxillary, ethmoidal air sinuses.Frontal, maxillary, ethmoidal air sinuses.
•Upper& lower teeth except lower incisors.Upper& lower teeth except lower incisors.
•Anterior 2/3Anterior 2/3rdrd of tongue.of tongue.
•Floor of mouth, vestibule.Floor of mouth, vestibule.
Drains into deep cervical nodes.Drains into deep cervical nodes.

60. 6060
BUCCAL LYPMH NODESBUCCAL LYPMH NODES
•Situated over buccinator muscleSituated over buccinator muscle
close to facial vein.close to facial vein.
•Receives lymph from Eyelids,Receives lymph from Eyelids,
cheek, mid portion of face rarelycheek, mid portion of face rarely
gums & palategums & palate
•Drains into submandibular lymphDrains into submandibular lymph
nodesnodes

61. 6161
PAROTID LYMPH NODESPAROTID LYMPH NODES
•Situated on/ within parotid gland.Situated on/ within parotid gland.
•Receives lymph fromReceives lymph from
a) Strip of scalp above parotid salivary gland.a) Strip of scalp above parotid salivary gland.
b) Lateral surface of auricle.b) Lateral surface of auricle.
c) Anterior wall of external auditory meatusc) Anterior wall of external auditory meatus
d) Lateral wall of external auditory meatus.d) Lateral wall of external auditory meatus.
e) Lateral wall of eyelide) Lateral wall of eyelid
•Drains into deep cervical nodesDrains into deep cervical nodes

62. 6262
MASTOID / RETROAURICULAR LYMPH NODESMASTOID / RETROAURICULAR LYMPH NODES
•Situated over lateral surface of mastoid process of temporalSituated over lateral surface of mastoid process of temporal
bonebone
•Receives lymph fromReceives lymph from
a)Strip of scalp above auricle.a)Strip of scalp above auricle.
b)Posterior wall of external auditory meatusb)Posterior wall of external auditory meatus
•Drains into deep cervical lymph nodesDrains into deep cervical lymph nodes

63. 6363
OCCIPITAL NODESOCCIPITAL NODES
•Situated at the apex of posteriorSituated at the apex of posterior
triangle of necktriangle of neck
•Receives lymph from back of scalpReceives lymph from back of scalp
•Drains into deep cervical lymphDrains into deep cervical lymph
nodesnodes

64. 6464
Anterior cervical nodesAnterior cervical nodes
•Lie along anterior jugular vein.Lie along anterior jugular vein.
•Drains skin of anterior part ofDrains skin of anterior part of
neckneck
•Efferents pass to deep cervicalEfferents pass to deep cervical
nodesnodes

65. 6565
Superficial cervical nodes :Superficial cervical nodes :
• Lie along external jugular vein superficial toLie along external jugular vein superficial to
sternocleidomastoid.sternocleidomastoid.
• Drains lobule of auricle, floor of external acousticDrains lobule of auricle, floor of external acoustic
meatus, skin over lower parotid region and angle of jaw.meatus, skin over lower parotid region and angle of jaw.
• It drains into deep cervical group of lymph nodesIt drains into deep cervical group of lymph nodes

66. 6666
B)B) LYMPHATIC DRAINAGE OF DEEP TISSUES OFLYMPHATIC DRAINAGE OF DEEP TISSUES OF
HEAD AND NECK:HEAD AND NECK:
RETROPHARYNGEAL NODES:RETROPHARYNGEAL NODES:
• Lie in front of prevertebralLie in front of prevertebral
fascia and behind buccopharyngeal fasciafascia and behind buccopharyngeal fascia
• Extend laterally in front of lateralExtend laterally in front of lateral
mass of atlas.mass of atlas.
• Drains pharynx, auditory tube, soft palate.Drains pharynx, auditory tube, soft palate.
• Efferents pass to upper deep cervical nodes.Efferents pass to upper deep cervical nodes.

67. 6767
b)b) PARATRACHEAL NODES:PARATRACHEAL NODES:
• Lie on sides of trachea andLie on sides of trachea and
esophagusesophagus
• Receives lymph from esophagus,Receives lymph from esophagus,
trachea and larynx.trachea and larynx.
• Efferent drains into lower jugularEfferent drains into lower jugular
group ,anterior mediastinal lymphgroup ,anterior mediastinal lymph
nodesnodes

68. 6868
c)c) PRELARYNGEAL AND PRETRACHEAL NODES:PRELARYNGEAL AND PRETRACHEAL NODES:
• Lie deep to investing fascia, on cricothyroid membrane .Lie deep to investing fascia, on cricothyroid membrane .
-Drains:-Drains:
upper node supra glottic larynxupper node supra glottic larynx
lower nodes infra glottic larynxlower nodes infra glottic larynx

69. 6969
• Pretracheal nodes in front ofPretracheal nodes in front of
trachea below isthmus of thyroidtrachea below isthmus of thyroid
gland.gland.
-Drains: region of thyroid gland and-Drains: region of thyroid gland and
tracheatrachea

70. 70
d)d) LINGUAL NODESLINGUAL NODES::
• SmallSmall
• Situated on external surface of hyoglossus and alsoSituated on external surface of hyoglossus and also
between genioglossi.between genioglossi.
• Drain into upper deep cervical nodes.Drain into upper deep cervical nodes.

71. 7171
LYMPHATIC DRAINAGE OF INDIVIDUALLYMPHATIC DRAINAGE OF INDIVIDUAL
ORGANS OF HEAD AND NECKORGANS OF HEAD AND NECK
Lymphatic drainage of scalp and earLymphatic drainage of scalp and ear
• Anterior part of scalpAnterior part of scalp pre-auricular lymphpre-auricular lymph
nodesnodes
• Posterior part of scalp post-auricular (mastoid) ,Posterior part of scalp post-auricular (mastoid) ,
occipital lymph nodesoccipital lymph nodes
• External acoustic meatus, middle ear and auditoryExternal acoustic meatus, middle ear and auditory
tube deep parotid lymph nodestube deep parotid lymph nodes

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Lymphatic drainage of faceLymphatic drainage of face
• Upper part Parotid Lymph nodesUpper part Parotid Lymph nodes
• Middle partMiddle part Submandibular lymph nodesSubmandibular lymph nodes
• Lower partLower part Submental lymph nodesSubmental lymph nodes

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Lymphatic drainage of deep tissue of head and neckLymphatic drainage of deep tissue of head and neck
- Head and neck tissues to deep fascia- Head and neck tissues to deep fascia
Deep cervical lymph nodesDeep cervical lymph nodes
- Nasopharynx, pharyngotympanic membrane.- Nasopharynx, pharyngotympanic membrane.
RetropharyngealRetropharyngeal
- Trachea, esophagus, thyroid- Trachea, esophagus, thyroid
ParatrachealParatracheal

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Lymphatic drainage of mouth, teeth, tonsil, tongueLymphatic drainage of mouth, teeth, tonsil, tongue
GingivaGingiva Submandibular lymph nodesSubmandibular lymph nodes
Hard palateHard palate Superficial deep cervical andSuperficial deep cervical and
retropharyngealretropharyngeal
Soft palateSoft palate RetropharyngealRetropharyngeal
Floor of the mouthFloor of the mouth Submental (deep cervical)Submental (deep cervical)
TeethTeeth Submandibular and deep cervicalSubmandibular and deep cervical
TonsilTonsil Jugulo digastric nodesJugulo digastric nodes

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TongueTongue
• Anterior 2/3rd submandibularAnterior 2/3rd submandibular
and deep cervicaland deep cervical
• Tip Submental (deep cervical)Tip Submental (deep cervical)
• Posterior 1/3rdPosterior 1/3rd JuguloJugulo
digastric lymph nodes.digastric lymph nodes.

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Lymphatic drainage of nasal cavity and paranasalLymphatic drainage of nasal cavity and paranasal
sinus:sinus:
• Mucous membrane of nasal cavity and anterior partMucous membrane of nasal cavity and anterior part
Submandibular and deep cervical lymph nodesSubmandibular and deep cervical lymph nodes
• Posterior partPosterior part Deep cervicalDeep cervical

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EXAMINATION OF LYMPH NODESEXAMINATION OF LYMPH NODES
1. Lymph nodes should be examined from patients behind.1. Lymph nodes should be examined from patients behind.
2. Examination is done by asking patient to flex his neck2. Examination is done by asking patient to flex his neck
slightly to reduce tension of musclesslightly to reduce tension of muscles
3. To palpate, use the pads of all four fingertips.3. To palpate, use the pads of all four fingertips.
4. Examine both sides of head simultaneously while applying4. Examine both sides of head simultaneously while applying
steady gentle pressure.steady gentle pressure.

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ANTERIOR/POSTERIOR CERVICAL LYMPH NODESANTERIOR/POSTERIOR CERVICAL LYMPH NODES
•They lie anterior & posterior to sternomastoid muscle.They lie anterior & posterior to sternomastoid muscle.
•Tip of fingers are used to palpate anterior nodes, medial toTip of fingers are used to palpate anterior nodes, medial to
sternomastoid muscle and posterior nodes behind the musclesternomastoid muscle and posterior nodes behind the muscle
while patient’s head tipped slightly forwards.while patient’s head tipped slightly forwards.

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SUBMANDIBULAR NODESSUBMANDIBULAR NODES
Palpated from behind the patient, with patient’s chin tippedPalpated from behind the patient, with patient’s chin tipped
slightly towards the chest.slightly towards the chest.

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SUBMENTAL NODESSUBMENTAL NODES
Roll the fingers below the chin(in the midline) with patient’sRoll the fingers below the chin(in the midline) with patient’s
head tilted forwardshead tilted forwards

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PAROTID NODES/PREAURICULAR NODESPAROTID NODES/PREAURICULAR NODES
Roll the finger in front of ear , against the maxillaRoll the finger in front of ear , against the maxilla

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POSTAURICULAR/ MASTOID NODESPOSTAURICULAR/ MASTOID NODES
Roll the finger behind the earRoll the finger behind the ear

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CAUSES OF ENLARGEMENT OF LYMPH NODESCAUSES OF ENLARGEMENT OF LYMPH NODES
 InflammatoryInflammatory
(a) Acute Lymphadenitis(a) Acute Lymphadenitis
(b) Chronic Lymphadenitis(b) Chronic Lymphadenitis
(c) Lymphogranuloma inguinale(c) Lymphogranuloma inguinale
 NeoplasticNeoplastic
(a) Benign – non-existent(a) Benign – non-existent
(b) Malignant(b) Malignant
1. Primary1. Primary
(i) Lymphosarcoma(i) Lymphosarcoma
(ii) Hodgkin’s disease.(ii) Hodgkin’s disease.
2. Secondary2. Secondary
(i) Sarcoma(i) Sarcoma
(ii) Malignant melanoma(ii) Malignant melanoma
(iii) Carcinoma(iii) Carcinoma

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 Autoimmune DisordersAutoimmune Disorders
(i)(i)AIDSAIDS
(ii) Juvenile rheumatoid arthritis(ii) Juvenile rheumatoid arthritis
(iii) Other collagen diseases such as Polyarteritis(iii) Other collagen diseases such as Polyarteritis
nodosa and scleroderma.nodosa and scleroderma.

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CAUSES OF INDIVIDUAL LYMPH NODECAUSES OF INDIVIDUAL LYMPH NODE
ENLARGEMENTENLARGEMENT
Sub mandibular NodesSub mandibular Nodes
• ConjunctivitisConjunctivitis
• SinusitisSinusitis
• TonsillitisTonsillitis
• PharyngitisPharyngitis
Sub mental NodesSub mental Nodes
•PeriodontitisPeriodontitis
•EBV infectionsEBV infections
•CMV infectionsCMV infections
•ToxoplasmosisToxoplasmosis

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Deep cervical nodesDeep cervical nodes
•PharyngitisPharyngitis
•RubellaRubella
•LymphomaLymphoma
•TuberculosisTuberculosis
•Head and neck cancerHead and neck cancer
Occipital nodesOccipital nodes
•Local infectionLocal infection
•Secondary SyphilisSecondary Syphilis
•NeoplasmNeoplasm

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Postauricular nodesPostauricular nodes
•Otitis ExternaOtitis Externa
•Secondary SyphilisSecondary Syphilis
•RubellaRubella
Preauricular nodesPreauricular nodes
•Local infectionLocal infection
•Herpes ZosterHerpes Zoster
•RubellaRubella
• SyphilisSyphilis
•TuberculosisTuberculosis

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REFERENCESREFERENCES
GRAY’S ANATOMY- 38GRAY’S ANATOMY- 38thth editionedition
CUNNINGHAM’S TEXTBOOK OF ANATOMY-12CUNNINGHAM’S TEXTBOOK OF ANATOMY-12thth
editionedition
NETTER’S ATLAS OF EMBRYOLOGY- LARRYNETTER’S ATLAS OF EMBRYOLOGY- LARRY
COCHARDCOCHARD
 TEXTBOOK OF HUMAN HISTOLOGY – INDERBIRTEXTBOOK OF HUMAN HISTOLOGY – INDERBIR
SINGHSINGH
 B. D. CHAURASIA – 4B. D. CHAURASIA – 4thth editionedition
 ESSENTIALS OF MEDICAL PHYSIOLOGY-ESSENTIALS OF MEDICAL PHYSIOLOGY-
K SEMBULIGAM-5K SEMBULIGAM-5thth editionedition

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