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Lymphatic drainage from the head and neck travels either via paired superficial or deep cervical nodes and vessels on either side of the neck. Ultimately, all lymph courses into a deep chain where it drains into the venous system at the base of the internal jugular vein.

Gross Anatomy

A horizontal band of nodes encircles the craniocervical junction

Submental; in the midline below the chin. Drains anterior lower oral cavity

Submandibular; in submandibular triangle. Drains remainder of oral cavity, cheek, nose, forehead and anterior half of nasal cavity & sinuses

Deep & superficial pre-auricular; lie deep and superficial to parotid. Drain middle scalp, pinna and parotid gland

Post-auricular; lie over the mastoid process. Drain pinna and posterior scalp

Occipital; located at the apex of the posterior triangle. Drain the posterior scalp


·       The deep cervical chain closely accompanies the internal jugular vein through its course, deep to sternocleidomastoid.

Jugulodigastric; drains upper pharynx and palatine tonsils

Jugulo-omohyoid; drains posterior half of nasal cavity and sinuses, and hard & soft palates

Retropharyngeal; drains pharynx

Paratracheal; drains larynx, trachea, thryroid & parathyroids


·       Superficial cervical chains accompany the external and anterior jugular veins, between them receiving lymphatic drainage from the whole antero-lateral cervical skin


·       Both the circular nodal chain and the superficial cervical chain drain into the deep cervical chain, where efferent lymph vessels form the jugular lymphatic trunk

This drains into the thoracic duct on the left or a common lymphatic trunk on the right.

These then drain lymph into the brachiocephalic vein at the junction of the subclavian vein and the internal jugular

Clinical Anatomy

·       Knowledge of which structures drain to which groups of lymph nodes is important for determining the metastatic spread of head and neck cancers

·       Retropharyngeal nodes sit posterior to the pharynx; when enlarged they bulge anteriorly (due to pre-vertebral fascia posteriorly) putting pressure on the pharynx, causing dysphagia

·    A modified radical neck dissection involves removing all Level I – V nodes, whilst attempting to preserve as much as possible of sternocleidomastoid, the internal jugular vein and Accessory nerve (CN XI) 

Quick Anatomy

Key Facts

Quick-look box – Cervical lymphatic levels

Level I

 Submental & submandibular nodes

Level II

 Between base of the skull & the hyoid bone

Level III

 Between the hyoid bone & cricoid cartilage

Level IV

 Between cricoid cartilage & the clavicle

Level V

 Nodes in the posterior triangle

Level VI

 Nodes surrounding midline viscera

Level VII

 Nodes in the superior mediastinum


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All lymphatic drainage from the head and neck passes into the deep cervical nodes, either directly or indirectly via the superficial nodes before draining into the subclavian vein. Superficial structures drain superficially and deep structures deep. Lymph nodes can be classified into levels in the context of treating malignancy.


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