Lymphatic system of the neck

Submandibular lymph nodes

Submandibular lymph nodes (nodi lymphatici submandibulares) are topographically located superficial to the second fascia of the neck (superficial lamina). Some of them may be located directly within the thickness of the fascial layer. The main landmark for locating them is the adipose tissue accompanying the facial blood vessels.

An important anatomical transition point is considered to be the place where the facial vessels loop over the lower margin of the mandible. This area is located at the anterior margin of the masseter muscle (m. masseter).

Zones from which lymph drains into the submandibular group:

• Medial (inner) part of the eyelids.
• Tissues of the external nose.
• Mucous membranes of the lips, gums, and cheeks.
• Structures of the floor of the oral cavity.
• Middle part of the tongue.

Clinically, it is important to remember the rule of regional drainage in inflammatory eye diseases: if the focus is on the inner part of the lower eyelid, the submandibular nodes will react. When inflammation is localized on the outer part of the eyelid, the parotid lymph nodes are involved in the process.

Deep cervical lymph nodes

The deep group of lymph nodes forms a chain along the anterior and outer walls of the internal jugular vein along its entire length. In the upper third of this chain, the upper group of nodes is distinguished, localized along the lower margin of the posterior belly of the digastric muscle.

The most significant element here is the jugulodigastric lymph node (nodus lymphaticus jugulodigastricus). It is located precisely in the area of intersection of the internal jugular vein and the posterior belly of the digastric muscle. Its key function is collecting lymph from the posterior third of the tongue.

Efferent vessels emerge from the deep cervical lymph nodes and merge into a single jugular trunk (truncus jugularis). This trunk topographically runs posterior to the internal jugular vein, heading towards the sites of entry into the large venous angles.

Main lymphatic ducts

The lymphatic system of the neck ends with large collectors—the thoracic and right lymphatic ducts, which have an asymmetrical structure and different pathways of formation.

Thoracic duct on the left (ductus thoracicus): Ascending into the neck along the posterior wall of the esophagus, the duct passes in a narrow space between the internal jugular vein (located anteriorly) and the vertebral vein (posteriorly). Next, it forms a characteristic arch curving around the posterior wall of the internal jugular vein at its lateral margin. The duct completes its path by emptying into the left venous angle (Pirogov's angle). The left jugular and left subclavian lymphatic trunks empty into it in the same region.

Right lymphatic duct (ductus lymphaticus dexter): Unlike the thoracic duct, it has a significantly shorter length and is formed by the confluence of three large right trunks: the jugular, subclavian, and bronchomediastinal. The duct opens into the right venous angle or directly into the subclavian vein. In many people, a single right duct is absent, and then the listed trunks empty into the venous bed separately.

Lymphatic system of the lateral triangle

Within the lateral triangle of the neck, three distinct groups of lymph nodes are topographically distinguished:

1. Nodes accompanying the accessory nerve (n. accessorius).
2. Nodes running along the course of the superficial cervical artery.
3. Supraclavicular group — the most constant of the three, localized along the suprascapular artery.

Supraclavicular lymph nodes collect lymph from the tissues of the lateral triangle of the neck itself and the breast. The left supraclavicular group is of particular clinical importance: lymph can be refluxed here from the thoracic cavity organs and organs located below the diaphragm. It is here that specific metastases in gastrointestinal cancers are detected (the so-called Virchow's nodes).

Topography and syntopy of adjacent structures

The surrounding neurovascular formations are in close contact with the elements of the lymphatic system.

On the right, the venous angle is located anterior to the arterial structures. The right vagus nerve (n. vagus) descends along the anterior surface, from which the recurrent laryngeal nerve (n. laryngeus recurrens) branches off, looping around the artery from below and behind. Laterally to the vagus nerve runs the right phrenic nerve (n. phrenicus). Between them, the subclavianansa (ansa subclavia) of the sympathetic trunk encircles the artery.

On the left, the structures lie deeper and are covered by the common carotid artery (a. carotis communis). Medial to them are the esophagus and trachea. The thoracic lymphatic duct runs between the left subclavian and common carotid arteries, looping around the vessel posteriorly and superiorly.

Posterior to the vessels, medial to the origin of the vertebral artery, lies the cervicothoracic (stellate) ganglion (ganglion cervicothoracicum / stellatum). It is formed by the fusion of the lower cervical and first thoracic sympathetic ganglia. The branches of this ganglion intertwine around the vessels, forming the vertebral (plexus vertebralis) and subclavian (plexus subclavius) nerve plexuses.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Formation and boundaries of the lateral triangle of the neck.
• Syntopy of the vagus and recurrent laryngeal nerves in the neck region.
• Topographic anatomy of the stellate (cervicothoracic) ganglion.
• Venous angles (Pirogov's angles) and variants of the venous bed of the neck.
• Fasciae of the neck: classification and their connection with the lymphatic system.

Other topics in "Topographic Anatomy of the Neck"

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