Lymph nodes of the head
The main accumulations of lymphoid tissue in the head are concentrated around the major salivary glands, along blood vessels, and in fascial spaces.
- Deep parotid nodes (nodi parotidei profundi). Numbering 3 to 10, they are located along the course of the superficial temporal artery. Depending on their topography relative to the parotid salivary gland, preauricular, infraauricular, and intraglandular nodes lying directly within the parenchyma are distinguished.
- Facial nodes (nodi lymphoidei faciales). They lie along the course of the facial artery. These include the buccal, nasolabial, zygomal (malar), and mandibular nodes.
- Submandibular nodes (nodi lymphoidei submandibulares). These include 6–10 structures located in the submandibular triangle along the base of the mandible. Some of them may lie within the salivary gland itself.
- Submental nodes (nodi lymphoidei submentales). These are 2–8 nodes lying on the anterior surface of the mylohyoid muscles, just above 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 below the hyoid bone. Deep nodes surround the organs of the neck: prelaryngeal, thyroid, as well as pretracheal and paratracheal nodes (the latter transition into the paratracheal nodes in the thoracic cavity).
- Lateral cervical nodes (nodi lymphoidei cervicales laterales). The superficial group (4–5 nodes) accompanies the external jugular vein. Deep nodes (10–15 in number) run along the internal jugular vein and are divided into upper and lower groups. Important landmarks among them include the jugulodigastric node (nodus jugulodigastricus) at the angle of the mandible, and the juguloomohyoid node (nodus juguloomohyoideus), which lies posterior to the tendinous intersection 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 omotrapezius triangle.
- Retropharyngeal nodes (nodi retropharyngeales). Fixed on the posterolateral wall of the pharynx.
Outflow 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. Outflow goes to the occipital and mastoid nodes, from which efferent vessels head toward 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 the superficial, then deep parotid nodes, and further into the deep lateral cervical nodes. Note: lymph from the tympanic membrane and external acoustic meatus also flows to the parotid nodes.
From the lips, cheeks, and medial eyelids, fluid flows to the submandibular nodes. The exception is the center of the chin and the medial part of the lower lip—vessels from these areas run to the submental nodes.
Outflow pathways: deep vessels and tongue
Deep vessels drain the mucous membranes, bones, muscles, and deep glands.
- Lymph from the hard and soft palate, nasal cavity, pharynx, middle ear, and lacrimal gland is directed to the retropharyngeal and deep parotid nodes.
- From the teeth, gums, conjunctiva, and most salivary glands, lymph is collected into the submandibular nodes, from where it passes into the deep cervical chain.
Lymph drainage from the tongue has a strict regional pattern. Vessels from the body of the tongue carry lymph to the deep cervical, submandibular, and retropharyngeal nodes. However, outflow from the apex of the tongue occurs specifically—strictly into the submental lymph nodes.
Briefly: answers to topical questions
Where does lymph drain from the palatine tonsils?
Lymph from the palatine tonsils drains via vessels piercing the pharyngeal wall. The outflow leads to the retropharyngeal or deep cervical lymph nodes.
Where does lymph drain from the thyroid gland?
The lymphatic vessels of the thyroid gland direct outflow into the pretracheal and paratracheal lymph nodes. From there, lymph enters the deep lymph nodes of the neck. Tracheal lymph nodes are also located near the posteromedial surface of the lobes.
Where are the occipital lymph nodes located?
The occipital lymph nodes are located on the posterior surface of the neck near the muscle attachment sites. They receive lymph from the posterior group of superficial head vessels.
Where are the mastoid lymph nodes located?
The mastoid lymph nodes are located behind the auricle, in the region of the mastoid process, superficial or deep to the sternocleidomastoid muscle. They receive lymph from the parietal-occipital region, the posterior surface of the auricle, the external acoustic meatus, and the tympanic membrane.
To remember tongue drainage, visualize its position: the anterior-most part (apex) drains lymph into the anterior-most nodes (submental), while the deeper part (body) drains into the submandibular and deep cervical nodes.
Class and exam questions
Where does lymph drain from the teeth and gums?
The main pathway of lymph drainage from the teeth, gums, and oral vestibule mucosa leads to the submandibular lymph nodes.
Where is the jugulodigastric node located?
This large node (nodus jugulodigastricus) belongs to the upper deep lateral cervical nodes and is localized at the level of the mandibular angle.
Are there lymphatic vessels in the eyeball?
No, there are no lymphatic vessels inside the eyeball. However, they are present in the conjunctiva, from which lymph flows to the submandibular nodes.
What else to study on this topic
- Topography of the deep lateral cervical lymph nodes
- The connection of the paratracheal nodes with the lymphatic system of the thoracic cavity
- Features of lymph drainage from various zones of the lips and cheeks
- Formation of the jugular lymphatic trunks
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