LYMPH NODES Prof. Peter Stanko, MD, PhD Oral and Maxillofacial Surgeon Dpt. of Stomatology & Maxillofacial Surgery Comenius University, St Elisabeth Hospital

Questions included 53. Superficial lymph drainage of the face and neck 54. Deep lymph drainage of the face and neck

LYMPH DRAINAGE of the FACE and NECK A. Lymph nodes of the face B. Lymph nodes of the neck C. Lymph nodes of the tongue

A. Lymph nodes of the FACE 1. Nodi lymphatici faciales 2. Nodi lymphatici parotidei 3. Nodi lymphatici retroauriculares (mastoidei) 4. Nodi lymphatici occipitales 5. Nodi lymphatici submentales 6. Nodi lymphatici submandibulares 7. Nodi lymphatici sublinguales 8. Nodi lymphatici retropharyngei

A. Lymph nodes of the FACE 1. Nodi lymphatici faciales -nodus nasolabialis (not always present) -nodus malaris (under lateral eye angle) -nodi buccinatorii (lay in line connecting tragus with angle of the mouth, within v. facialis and corpus adiposum buccae). They drain into parotideal lymph nodes. -nodus mandibularis (above mandible within anterior margin of musc. masseter a a.facialis). 2. Nodi lymphatici parotidei -profundi (3-4 in parenchyma of the gl. parotis) -superficiales (on surface of capsule of the gland). 3. Nodi lymphatici retroauriculares (mastoidei) -posteriores -inferiores. 4. Nodi lymphatici occipitales.

A. Lymph nodes of the FACE - continue 5. Nodi lymphatici submentales -a group closer to insertion of venter ant. musc.digastrici on the mandible, -a group closer to the hyoid bone.    6. Nodi lymphatici submandibulares (approximately 6 – 10) -anteriores (close to venter ant. musc. digastrici + v. mentalis), -medii (at upper margin of gl. submandibularis, in site of ascendent part of a. facialis), -posteriores (behind v. facialis). Afferent lymph vessels of the submandibular lymph nodes bring lymph from major part of the face (nose, upper lip, half of the lower lip, cheeck) and of the mouth (maxillary teeth, mandibular teeth with exception of lower incisors, surrownding gingíva, tongue and floor of the mouth). Efferent lymph vessels bring lymph to the neck lymph nodes. 7. Nodi lymphatici sublinguales (bring lymph to lymphonodi cervicales profundi) -mediales (on musc. genioglossus), -laterales (within musc. genioglossus + musc. hyoglossus). 8. Nodi lymphatici retropharyngei (sentinel LNs for lymphonodi cervicales profundi) -mediales -laterales.

B. Lymph nodes of the NECK ► By anatomical position are dividable into anterior and lateral subgroups. ► Every group can be divided into superficial and deep subgroups. 1. Nodi lymphatici cervicales anteriores superficiales 2. Nodi lymphatici cervicales anteriores profundi (juxta-viscerales) 3. Nodi lymphatici cervicales laterales superficiales 4. Nodi lymphatici cervicales laterales profundi

B. Lymph nodes of the NECK 1. Nodi lymphatici cervicales anteriores superficiales 2. Nodi lymphatici cervicales anteriores profundi (juxta-viscerales) -nodi praelaryngei et thyreoidei -nodi praetracheales -nodi laterotracheales. 3. Nodi lymphatici cervicales laterales superficiales

B. Lymph nodes of the NECK 4 B. Lymph nodes of the NECK 4. Nodi lymphatici cervicales laterales profundi Nodi lymphatici cervicales laterales profundi form the largest subgroup of cervical LNs. ● Nodi jugulares interni (2 chains of lymph nodes, anterior and lateral, positioning from skull base to angulus venosus, with many anastomoses form truncus jugularis). From clinical point of view of great importancy are: Nodus lymphaticus tonsillaris (Wood) – in level of the 3rd cervical spine in anterior chain. Nodus jugulodigastricus (the main LN, called Küttner´s or Chassaignac´s) – in site where v. jugularis int. is crossing posterior belly of musc. digastricus, tributary region is last third of the tongue and ishmus faucium. Nodus juguloomohyoideus or omojugularis (Kocher´s or Poirier´s LN) with tributary region of middle mandible and apex of the tongue directly or trough nodi submentales. ● Nodi communicantes n.accesorius (continue into nodi supraclaviculares) ● Nodi supraclaviculares (mediales et laterales) drain lymph not only from head and neck organs, but also from other body regions (milk gland, chest wall, lungs and occasionally from upper limbs and stomac – Virchow´s LN). Efferentné lymph vessels form truncus supraclavicularis, which continues into ductus thoracicus or truncus lymphaticus dexter.

B. Lymph nodes of the NECK 4 B. Lymph nodes of the NECK 4. Nodi lymphatici cervicales laterales profundi ● Nodi jugulares interni (2 chains of lymph nodes, anterior and lateral, positioning from skull base to angulus venosus, with many anastomoses form truncus jugularis). From clinical point of view of great importancy are: ▪ Nodus lymphaticus tonsillaris (Wood) – in level of the 3rd cervical spine in anterior chain. ▪ Nodus jugulodigastricus (the main LN, called Küttner´s or Chassaignac´s) – in site where v. jugularis int. is crossing posterior belly of musc. digastricus, tributary region is last third of the tongue and ishmus faucium. ▪ Nodus juguloomohyoideus or omojugularis (Kocher´s or Poirier´s LN) with tributary region of middle mandible and apex of the tongue directly or trough nodi submentales.

LEVELS of the lymph nodes

C. Lymph nodes of the TONGUE Lymphatic net in the tongue brings the lymph within muscles into sentinel nodi sublinguales and then continues into deep cervical LNs. The lymph nodes form 4 groups: - anterior (apical) group, - lateral + marginal group, - central group, - posterior (basal) group.

Clinical value of the knowledge Spread of cancer cells may be to the same side as the tumour, but also to the opposite side as the tumour or can occur bilaterally.  

Notice – LYMPHATIC VESSELS Efferent lymphatic vessels from deep cervical lymph nodes form on each side truncus jugularis (l. dx., l. sin.). Then: - on the right side lead into ductus lymphaticus dexter - on the left side lead into ductus thoracicus.