Lymph nodes of head & neck
Superficial Cervical lymph nodes
Deep Cervical Nodes
Innermost (waldeyer’s)or tonsillar ring
Cervical lymph nodes
• Superficial Cervical lymph nodes:
• The lymph nodes of the head and neck are arranged as a
regional collar that extends from below the chin to the back of
• Deep Cervical Nodes:
• The deep cervical nodes form a vertical chain along the course
of the internal jugular vein within the carotid sheath. They
receive lymph from all the groups of regional nodes. The
jugulodigastric node, which is located below and behind the
angle of the jaw, is mainly concerned with drainage of the tonsil
and the tongue. The jugulo-omohyoid node, which is situated
close to the omohyoid muscle, is mainly associated with
drainage of the tongue.
• The efferent lymph vessels from the deep cervical lymph nodes
join to form the jugular trunk, which drains into the thoracic duct
or the right lymphatic duct.
• Superficial group is situated
around the junction of head &
• These drain superficial structures
of head & some deep parts. Most
of efferents lymph vessels pass to
• Deep group occurs in a chain & are
arranged along internal jugular vein from
digastic to root of neck within the carotid
• These are divided into upper & lower
groups by omohyoid. They receive lymph
from all the groups of regional nodes
These also receive lymph from
behind_pharynx : retropharyngeal nodes.
Upper deep group
• Is situated in angle between the lower
border of mandible & SCM itself.
• These are related to IJV & posterior belly
of digastric_jugulodigastric nodes.(one of
these is called Tonsillar lymph node)
Lower border of
Lower deep group
• Is found in posterior triangle of neck in angle
between SCM & clavicle lying partially deep
• These are called called jugulo-omohyoid or
supraclavicular nodes. These receive lymph
from upper cervical group of breast & enter
in structure in thorax & abdomen. The
efferent from this form jugular trunk leading
to thoracic duct/right lymphatic duct.
The occipital lymph nodes
• Lie on upper end of trapezius & on fascia
at apex of posterior triangle, These are
situated over the occipital bone on the
back of the skull.
• They receive lymph from the back of the
scalp & back of neck. Drain to upper deep
(retromandibular/ mastoid) lymph nodes
• Lie on superior end of SCM,posterior to
auricle. These lie behind the ear over the
• They receive lymph from the scalp above
the ear, the auricle, and the external
auditory meatus. Drain to upper deep
cervical lymph nodes.
The Parotid lymph nodes
• Scattered through parotid gland. Drain
auricle, external auditory meatus, from the
scalp above the parotid gland, deep group
drain temporal & infratemporal fossa, the
middle ear, auditory tube, upper molar
teeth, & gums.
• Efferents drain to lower pole of parotid
gland to deep upper cervical lymph nodes
on external jugular vein.
The buccal lymph nodes
• Lie on buccinator. One or two nodes lie in
the cheek over the buccinator muscle.
They drain lymph that ultimately passes
into the submandibular nodes
The submental lymph nodes
• These lie in the submental triangle just
below the chin on fascia covering
myelohyoid between anterior bellies of
digastric. These drain lymph from a wedge
shaped zone which include incisor teeth &
gums & anterior part of floor of mouth.
Drain to deep cervical lymph nodes.
The submandibular lymph nodes
• Lie along submandibular gland mainly under
cover of mandible just below the lower margin of
the jaw.Receive lymph vessels from area below
the line joining the medial angle of eye & angle
of mandible. Deeper lymph vessels drain
submandibular & submenatal, the side of
tongue, gums, part of palate, anterior part of
walls of nasal cavity, the frontal, maxillary, and
• Drain to submandibular lymph nodes to deep
cervical lymph nodes.
The infrahyoid lymph nodes
• Lying in relation to larynx on thyrohyoid &
• Drain structures in the middle of neck.
The paratracheal lymph nodes
• Lying between trachea & oesophagus.
• Drain middle of neck to upper & lower
deep cervical lymph nodes.
The retropharyngeal lymph nodes
• Lie on fascia of posterior wall of upper
pharynx at level of mastoid process.
• Drain oral & nasal parts of pharynx,
palate, nose, PNS, auditory tube & middle
• Waldeyer's ring is a circumpharyngeal ring of
mucosa-associated lymphoid tissue which
surrounds the openings into the digestive and
• It is made up
– anteroinferiorly by the lingual tonsil,
– laterally by the palatine and tubal tonsils,
– posterosuperiorly by the nasopharyngeal tonsil
– smaller collections of lymphoid tissue in the inter-
Clinical Significance of the Cervical Lymph Nodes
• Knowledge of the lymph drainage of an organ or region
is of great clinical importance.
• Examination of a patient may reveal an enlarged lymph
• For example, an enlarged submandibular node can be
caused by a pathologic condition in the scalp, the face,
the maxillary sinus, or the tongue. An infected tooth of
the upper or lower jaw may be responsible. Often a
physician has to search systematically the various areas
known to drain into a node to discover the cause.
Examination of the Deep Cervical Lymph Nodes
• Lymph nodes in the neck should be
examined from behind the patient.
• The examination is made easier by asking the
patient to flex the neck slightly to reduce the
tension of the muscles. The groups of nodes
should be examined in a definite order to avoid
omitting any.After the identification of enlarged
lymph nodes, possible sites of infection or
neoplastic growth should be examined, including
the face, scalp, tongue, mouth, tonsil, and
Carcinoma Metastases in the Deep Cervical Lymph Node
• In the head and neck, all the lymph ultimately drains
into the deep cervical group of nodes. Secondary
carcinomatous deposits in these nodes are common.
The primary growth may be easy to find. e.g. larynx,
the pharynx, the cervical part of the esophagus, and
the external auditory meatus, the bronchi, breast, and
stomach. In these cases, the secondary growth has
spread far beyond the local lymph nodes.
• When cervical metastases occur, the surgeon usually
decides to perform a block dissection of the cervical
nodes. This procedure involves the removal en bloc of
the internal jugular vein, the fascia, the lymph nodes,
and the submandibular salivary gland. The aim of the
operation is removal of all the lymph tissues on the
affected side of the neck. The carotid arteries and the
vagus nerve are carefully preserved.