These are the occipital, mastoid, superficial and deep parotid, submandibular and submental lymph nodes. Nodi lymphatici occipitales, Lymphonodi occipitalesĪt the junction between the head and neck are five groups of lymph nodes which form the pericerivcal lymphatic circle, also called the pericervical collar. Pharyngeal lymphoid ring (pharyngeal, lingual, palatine and tubal tonsils)Īxillary nodes (lateral, anterior, posterior, central, apical) Pericervical lymphatic circle (occipital, mastoid, parotid (superficial and deep), submandibular and submental lymph nodes)ĭeep anterior cervical nodes (prelaryngeal, thyroid, pretracheal and paratracheal nodes)ĭeep lateral cervical nodes (superior and inferior deep lateral cervical nodes) Lymph nodes of the head, neck and upper limb receive, filter and transport lymphatic fluid from surrounding lymph nodes and viscera back into the bloodstreamįacial nodes (buccinator, nasolabial, malar and mandibular nodes) Key points about the lymph nodes of the head, neck and upper limb This article will discuss the anatomy and function of the lymph nodes of the head, neck and arm. Superficial and deep afferent and efferent lymphatic vessels drain lymph to and from these nodes to ultimately reach the subclavian lymphatic trunk. Lymph nodes of the upper limb include the cubital, axillary, infraclavicular and interpectoral lymph nodes. These lymph nodes receive lymphatic drainage from the lymph nodes of the head and drain into either the thoracic duct on the left or the right lymphatic duct. The lymph nodes of the neck are typically organized into superficial and deep nodes which are further classified into anterior and lateral cervical lymph nodes.

There are three main groups of lymph nodes within the head: the lingual lymph nodes, facial lymph nodes and a group of lymph nodes which form a ring at the junction between the head and neck known as the pericervical lymphatic circle. Lymph nodes of the head filter lymph from regions of the head, face and scalp and typically drain to the superficial and deep lymph nodes of the neck. Lymph nodes and vessels of the head, neck and upper limb are generally divided into superficial and deep groups. These levels are Ia, Ib, II, III, IV, V, VI, VII, VIII, IX, X.Lymph nodes of the head, neck and upper limb function to receive, filter and transport lymphatic fluid from surrounding tissues and viscera back into the bloodstream via the thoracic duct, right lymphatic duct and/or subclavian lymphatic trunk. The lymph nodes of the neck are further classified by level. These include the nasopharynx, pharyngeal wall, base of the tongue, soft palate, and larynx. Conversely, most structures drain ipsilaterally, except in the case of structures situated at the anatomic midlines. On the right side, they flow directly into the lymphatic duct. On the left side, they drain either directly into the vasculature via the jugulo-subclavian venous confluence or directly into the thoracic duct. From there it moves into the spinal accessory chain adjacent to the spinal accessory nerve, or cranial nerve XI, and then meets the supraclavicular chain. This lymphatic drainage originates at the base of the skull, then proceeds to the jugular chain adjacent to the internal jugular vein. These lymphatic chains are strongly lateralized and typically do not directly communicate between left and right in the absence of a pathologic process. Aponeuroses bind them together with the muscles, nerves, and vessels of the head and neck. The head and neck contains a rich and elaborate lymphatic network of more than 300 nodes and their intermediate channels.

A detailed understanding of the principle lymphatic nodal levels of the neck is required, including their anatomical configuration and boundaries, patterns of drainage, and risk of metastatic involvement in the context of malignancy.

This knowledge is especially crucial in guiding the approach to proper locoregional therapy, whether by surgery or irradiation. As such, intimate knowledge of the anatomic relationships of the lymphatic nodal levels and the structures they drain is critical in the delivery of appropriate therapy in many patients with cancers of the head and neck. The involvement of specific nodal groups is an indicator of pathologically-affected organs and tissues, especially in the context of malignancy. Lymphadenopathy is a significant clinical finding associated with acute infection, granulomatous disease, autoimmune disease, and malignancy. It is inclusive of osseous, nervous, arterial, venous, muscular, and lymphatic structures. The head and neck, as a general anatomic region, is characterized by a large number of critical structures situated in a relatively small geographic area.

Lymph nodes back of neck